Controversial proposal suggests defunding knee surgeries

Productivity Commission calls for health shake-up, land tax and road tolls.

Report urges major health shake-up

Low-value health care procedures such as knee arthroscopies would be defunded, and land taxes and road user tolls would be introduced under a series of controversial proposals suggested by the Productivity Commission on Tuesday.

The Shifting The Dial report, commissioned by Federal Treasurer Scott Morrison, acknowledges that Australia’s health care system is good, but suggests the list of problems with the industry is lengthy.

In reflecting on what works under the current system, the Commission states that Australians are living longer, and with less disability than ever before.

“Australia outranks most other highly developed economies in health outcomes. It has the third greatest life expectancy at birth among OECD countries in 2015 at 82.8 years and a high absolute number of years spent in good health,” the report reads.

The report also reveals that Australians spend more years suffering from ill health than in other developed nations.

The Commission decries the waste that exists in the health care system and the unnecessary procedures that still take place despite evidence that the likely benefit to the patient is nil.

“The evidence that arthroscopy for knee osteoporosis has no or low value in the bulk of instances has been known for more than a decade,” the report claims.

“Arthroscopy for knee degeneration is just one of many costly treatments lacking an evidence base or that do not pass a cost-effectiveness test.

“In Australia, approximately 75 per cent of acute bronchitis is treated with antibiotics, when the evidence suggests that the rate should be near zero.”

Some of the other recommendations for the health care sector are to allow people who are not as qualified as pharmacists to dispense medicines, while allowing trained pharmacists and future pharmacists to do some of the work currently undertaken by general practitioners.

Aside from healthcare the Productivity Commission’s report also recommends the introduction of a land tax to encourage people to move out of large homes on large blocks, allowing the land to be used for more efficient uses, and a user pays road-funding scheme.

Treasurer Scott Morrison welcomed the report on Tuesday.

“The Commission estimates the economic benefits from a health system reboot could be worth up to $200 billion over the next 20 years,” Mr Morrison said.

“This is not about allocating more resources or conversely cutting health budgets.

“It's about doing more with the investment in health we have already made. Doing things smarter and ensuring our increasing longevity is matched with quality of life.”

Opinion: Health is an investment not a cost

The Productivity Commission’s report makes it clear that spending on health is an investment worth pursuing, pointing to the increased productivity gains that can be made if people are able to work longer.

The Turnbull Government has too often set its narrow focus on trying to cut costs, rather than looking at the bigger picture. This has not been limited to healthcare.

We have seen the Government roll out a flawed National Broadband Network that is manifestly unsuitable for current demand under the auspices of saving a few bucks.

The Government also sees health and education as budget line items that are there to be cut, rather than an investment in the future of our country.

Hopefully, this report will encourage the Government to take up some of the recommendations aimed at increasing spending on preventative health measures, which can save money, but also contribute to better health outcomes.

While some of the healthcare recommendations are welcome, including a push to make the system more patient-focused in the future, there are a number of concerns in other areas.

The most alarming suggestion is a push to recoup money for road funding. The report points out that as more and more people start to shift towards hybrid or electric vehicles, the road funding model, which currently comes from fuel excise, will start to decrease.

It proposes investigating new measures for road funding, and while not making the suggestion explicitly, promotes the idea of tolls on all roads.

This idea would particularly hurt those who are unable to afford new electric cars, most likely those on fixed incomes, such as retirees, while hitting them with a potential double whack under any new road-funding agreement.

What do you think of the ideas in the Productivity Commission report? What would you like to see done to improve healthcare in Australia? 

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    COMMENTS

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    maelcolium
    25th Oct 2017
    10:25am
    Meh! The last gasps of a dying Government as they cater to the conservative element on their way out of the political door. We should ignore any of the so called reforms the PC has prepared at the behest of this bunch of no hopers. They are a spent force and will be consigned to the back benches next year so anything they pronounce will not come to pass. Malcolm won't be able to buy his way out of the coming demise. He is a dead duck.
    MICK
    25th Oct 2017
    10:39am
    Totally agree. More propaganda to shore up the Titanic.
    To this government health is an investment for citizens to make and a cost for governments to avoid. Personally I want my tax dollars spent on the necessities of life rather than Royal Commissions into the opposition and marriage equality postal votes, tax cuts for the wealthy.
    And you wonder why our debt has doubled in the past 5 years with nothing to show for it.
    Triss
    25th Oct 2017
    2:45pm
    I agree with you, maelcolium, and it really irrates me that Useless, mulit millionaire Malc will get a huge "as of right" pension and will not be told to downsize from his $52 million dollar home to help struggling familes.
    Mad as Hell
    25th Oct 2017
    3:50pm
    The LIBS and GREENS lost me with the changes to the Pensioner Assets Test. This is another nail in the coffin.
    MICK
    25th Oct 2017
    5:06pm
    It might help you to look at the bigger picture as well Mad as hell. Your complaint is small change compared to the fraud this lot are foisting on the nation and the payola going to mates who contribute money.
    Make a list of betrayals....but get a big piece of paper before you begin.
    Ted Wards
    25th Oct 2017
    10:30am
    Didn't you run an article just yesterday about the additional things you can do at the local chemists negating the need to go the doctors and sit in unhealthy waiting rooms because the pharmacist can do a lot more than dispense medication?
    We already pay road toles and land taxes in many states. I think maybe this is nothing more than a sign that the treasurer is out of touch with what is going on.
    If you watch some of the documentaries about psychiatry they will tell you there is absolutely no scientific evidence that any of the treatments from psychiatrist work. Look up the documentary entitled psychiatry and industry of death and psychiatry the killing machine. Both look at the history of the industry and show it has been one of experimentation, and then compares it with the obscene profits the big pharma companies make out of the tablets which the side affects alone are known to be worse than the initial problem. Think of the billions of health dollars we could save if we stopped supporting this placebo industry alone.
    KSS
    25th Oct 2017
    1:21pm
    No doubt you are also an anti-vaccination proponent too?
    musicveg
    25th Oct 2017
    7:29pm
    KSS why are you assuming Ted Wards is anti-vac, he is merely telling the truth about big pharma.
    Janus
    25th Oct 2017
    10:50am
    Th productivity Commission has a role: to show the economic effects of certain actions. They are concerned only with the dollar. Nothing to do with quality of life, personal security, happiness or anything else, just money: Jobs and Growth!

    I wonder (actually I don't) when the Liberals and Labor to a lesser extent will realise that we live in a COUNTRY, a NATION which the government in power is tasked with administrating for the benefit of the people. We do NOT live in a business, a project or a private enterprise.

    Once a government starts thinking about the bigger picture and actually CARING instead of preparing for the next election, we might get some decency back. I will be long dead and gone before that happens.
    Infinityoz
    25th Oct 2017
    11:01am
    Spot on Janus!
    MICK
    25th Oct 2017
    5:08pm
    "Caring"? Now there is a good starting point to discredit the current government. The only thing this lot care about is re-election. Beyond that betrayal is the only word which paints the correct picture.
    musicveg
    25th Oct 2017
    7:31pm
    The only thing they care about is increasing their personal wealth and the rest of the oglichary mates.
    john no
    25th Oct 2017
    11:05am
    Sell my house, free up large blocks for smaller houses and loose my center link pension, right, so who gains exactly? apart from the developers who fund the Lib Nat parties.
    Captain
    25th Oct 2017
    1:00pm
    We live in a large house on a reasonably large block, however in our area there are restrictions covering everything, blocks cannot be subdivided, new houses must meet strict criteria to maintain the ambience of the neighbourhood, trees cannot be trimmed if they are over a certain height or limb circumference without licence from the Local Council, and many other restrictions. These restrictions are set by the Council and the State Govt.

    If any land tax comes in, people like us would most probaly be caught up in it. We do not want to downsize, it is our family home and relatives from overseas regularly come over to visit and stay with us.

    We are both well over 65 and not on a pension of any kind (and intend to stay that way). I am sure that there will be others in our situation or similar to us, so there will need to be a review process not just a one size fits all solution. However we all know what the answer to that will be.
    musicveg
    25th Oct 2017
    7:35pm
    Another money grabbing scheme, why should people have to sell their land, if I owned a house with a big block I would enjoy the space. We are losing our freedom of choice of how we want to live because of the oligarchy governments in this world.
    Charlie
    25th Oct 2017
    11:06am
    All I can say is, it must be bad in other countries.
    I spent most of my life in good health but still didn't make it over the line to 65 without serious illness.
    Kathleen
    25th Oct 2017
    11:41am
    MRI is needed to look at the knee properly because of the small bones. This government is hell bent on deconstructing our health system including Medicare and medications that work. With the latter, cheaper versions have issues with the mixing and coating which people are reporting over and over. This government has made too many mistakes that people will not forgive at the next election.
    musicveg
    25th Oct 2017
    7:36pm
    At this rate we will end up where the USA is, no one can afford to go to the doctor because of the huge costs of gap payment and extra services.
    Nerk
    25th Oct 2017
    12:03pm
    They cannot legally charge a toll on the "Queens hi way" however one day if we become a republic or what ever then hang on to your check book.
    Eddy
    26th Oct 2017
    7:40pm
    Hey Nerk, should that be 'cheque book', one of my pet aversions is the Americanisation of our language and culture.
    GrumpyOldMan
    25th Oct 2017
    12:19pm
    I get more frustrated each day at the absolute unwillingness of this government to stray from their path. They do treat the country like a business and unless it's making huge profits at the expense of the lowest paid and those who can least afford it, they don't seem to imagine there is any alternatives. If you haven't watched it yet, head to SBS on demand or Youtube and look for Michael Moore's film: "Where to Invade next". Every politician and elected official who is placed into a position of benefiting the country as paid employees of the public should be forced to watch this film before coming up with any more crackpot schemes that only serve to benefit themselves or their cronies. PLEASE, watch it and persuade everyone you know to view it before the next election and ask your local representative why aren't we following those countries who have adopted a more caring attitude and if they will support us heading in the same direction.
    MICK
    25th Oct 2017
    5:10pm
    I need to tell you something Grumpy: this government fills almost every position of power and responsibility with one of the cronies. The they sing from the same song sheet.
    musicveg
    25th Oct 2017
    7:38pm
    You might be interested in reading Bernie Sanders book, I am in the second half of it and it is mind blowing politics of the USA which seems this current government wants to emulate.
    MICK
    25th Oct 2017
    8:29pm
    It is screaming to copy the US as this lot and its rich backers want its slaves on tap. Nobody would believe the blatant propaganda media outlets with their lies. Pretty sickening....and the mentally challenged are lapping it up.
    Bellbird
    25th Oct 2017
    12:36pm
    I am no fan of the current bunch of feds, but road user toll based on mileage covered would be much fairer registration substitute for many retired people. Most of us cover very small distances per year and to slug us with the same major component on our registration as people who use the roads more often is inequitable. The states of course would have to come to the party. Arthroscopies are pretty useless and can produce complications, so no problem with that one. Would not trust folks with less training than pharmacists to dispense medicines.
    Janran
    25th Oct 2017
    4:05pm
    We are already paying a road tax when we pay our car rego, which is based on one's cc engine capacity. And the fuel excise we pay also goes to the Govt.

    I say ban new Tollways in the big cities and INVEST IN FIRST CLASS PUBLIC TRANSPORT SYSTEMS, ffs. Without decent public transport, traffic congestion just gets worse and worse. "We need a new tunnel" they cry, and as soon as it's built (by a private consortium who will impose a new Toll), it's full of traffic. Back to where we started.

    Our Govts need to take the bull by the horns and look after the people's needs. Why else are we paying tax!

    A decent society, where the lowest socio-economic rung are not driven to crime to exist and make all our lives miserable, is far more valuable than GNP growth. Big business whole-heartedly disagrees with me, but I didn't vote for big business, so they should remove their ugly snouts out of the tax-funded revenue trough.
    Spondonian
    25th Oct 2017
    4:13pm
    Mileage based taxingis already with us. Every ltr of fuel carries tax so the more mileage you do the more you pay. Thats fair enough with out paying more .
    Rae
    25th Oct 2017
    4:47pm
    Very true Spondonian. It seems the push to tax ordinary people so as to increase business profits rolls on and on without new ideas just a second tax called something else.
    musicveg
    25th Oct 2017
    7:40pm
    Anymore road taxes will kill small business, give Australia Post more excuse to up their postage costs, and see many couriers and other road based business die, leaving again only the big players.
    KSS
    25th Oct 2017
    1:28pm
    Why are people reacting as if this is all now Government policy?

    It isn't!
    MICK
    25th Oct 2017
    5:11pm
    It paints a picture and demonstrates the way this lot is heading KSS. That is entirely the point.

    25th Oct 2017
    3:15pm
    Anything the Lieberal a**eholes propose is designed to disadvantage the poor - including pensioners - while featherbedding the rich. Kick these scumbags out of office as soon as possible.

    25th Oct 2017
    3:50pm
    I don't agree that people without a pharmacist's qualifications should be allowed to dispense medicines authorised by a GP. I was prescribed a medication and queried why the pharmacist rang the GP. Apparently, the GP had overlooked the reaction of my current medication with the new prescription. On another occasion I witnessed a pharmacist ringing a GP to advise that the medication prescribed had an alcohol base and the patient was a recovering alcoholic. Would a non-qualified person have picked these up?
    musicveg
    25th Oct 2017
    7:42pm
    So true, you need a chemist who understands the make up of all the medications. GP's don't even know about the medications so how on earth is anyone less qualified able to dispense them safely.

    25th Oct 2017
    3:52pm
    If any government wants to increase road funding, all that is needed is to put all of the proceeds of the petrol excise aside for roads. Successive governments since the 1940's have reduced the spending of roads from the petrol excise and have used the balance for other portfolios. At present only about 20% of the petrol excise comes back for roads.
    MICK
    25th Oct 2017
    5:13pm
    Put the proceeds to what it is supposedly intended? Don't be daft. Straight to Consolidated Revenue....where your pension is sitting.
    musicveg
    25th Oct 2017
    7:46pm
    What about stopping the fuel tax credits that mining companies get? That could fix a few roads.
    MICK
    25th Oct 2017
    8:21pm
    Yep. The tip of an iceberg.
    What about offshore Tax Shelters for rich Australian avoiding tax?

    25th Oct 2017
    4:19pm
    Yes - we need to make taxpayers dollars go further AND only spent on essentials.
    Health sector efficiency and effectiveness has been a serious drain on resources for decades
    pepa
    25th Oct 2017
    4:28pm
    I can’t understand how Mick can comment on this governments debt when Labor came in 2007 we had a good surplus and when Liberal came back in 2013 all that was gone and we were in debt to China. We are better off in our health system than many countries. In New Zealand they pay every time to visit their GP and we don’t pay a cent. Like many we are pensioners and still pay to stay in a health fund even though it is costly. I don’t believe in non qualified people prescribing medications or the many tests that pharmacists are performing these days
    MICK
    25th Oct 2017
    5:24pm
    Here's the reason pepa:

    1. ignore the lies which have been put out there by the Press which for the most part is owned and/or controlled by the big end of town which puts its side of politics into power.
    2. Labor had no debt coming into the GFC but it injected large amounts of capital into the economy to keep it running. You probably remember that hardly any Aussies were thrown onto the unemployment heap during Labor's term in office. Had the coalition been it it would have turned its back on Australians.
    3. Since Abbott was put into office by the Murdoch empire the 2 coalition governments removed the debt ceiling and have more than doubled the debt. Unlike Labor it did not spend the money on anything worth doing and worse than that sabotaged the NBN which Labor kicked off. Now Turnbull blames Labor when IT IS HIS FAULT.

    I am happy to have a discussion about debt but we need to be on the same page and you will need to look at both sides, their achievements and of course the money trail. This lot does little other than try to put new taxes and charges on working Australians and give the top tax cuts using lies to justify the unjustifiable.
    Baby Huey
    25th Oct 2017
    5:49pm
    The PC report just gives governments more ideas on how to screw taxpayers.
    pepa
    25th Oct 2017
    6:08pm
    Dear Mick what would have happened if there was no surplus? The GFC would have killed us.Then came school “buildings”,and from what I have seen in 3 schools the money was wasted. The schools were told what to build. Then came the pink batts what a disaster people were electrocuted. Then came the $900 odd Cheques some went to dead people some went to people living overseas. Oh the waste! Then the WORST decision that labor made caused the deaths of 1200 men,women and children. Remember that? What a terrible thing and labor wears that forever
    MICK
    25th Oct 2017
    8:27pm
    What a load of BS.
    Other countries had massive debt when the GFC hit. They are still operating.
    School halls and pink batts? So you believe that ALL school halls were built by crooks in the building industry. They weren't. I guess you also believe that public education deserves nix and that kids should get second hand text books instead of teachers.
    $900 handouts? I never believed in that and I never got one so be happy with what you got. The REASON for this madness...to kickstart the economy by getting people spending. I understand the incumbent government needed an instant hit to stimulate our economy but still consider it a waste. So how many dead people got this? One? Ten?
    As I said at the beginning, BS. Have a proper conversation, do some research and avoid preaching right wing propaganda which was put out there to get the worst government in living history into office. It worked because people are easily conned. They were.
    Anonymous
    26th Oct 2017
    12:37am
    Yes many countries had debt going into GFC
    What’s that got to do with anything,
    Fact is Australia had no debt and had a booming economy
    No need to go into debt and waste billions
    That idiot Rudd destroyed our future . He should be hung for being a self serving traitor
    Jim
    25th Oct 2017
    7:09pm
    All I can add to this discussion because I agree with most of the comments, is that if you think it's bad now wait until Bill gets in with the help of the looney left and the crazy greens, we will be a lot worse off, economics is a strange beast and statistics can be manipulated, but the one thing that never changes is when you create debt it costs heaps to service that debt, which is why the Libs are struggling to reduce the debt. We had good policies when Bob Hawke and Keating were running the country then Howard carried that stability on until Rudd Gillard Rudd fiasco has spiralled this country into a downward trend that we will struggle to reign in, such is life!
    musicveg
    25th Oct 2017
    7:52pm
    Bill will be better than Turnbull and I can't wait. Turnbull is full of lies and deceit.Has not kept any of his promises. Although I would still rather a fresh face and new party on the scene, someone like Bernie Sanders in the USA.
    Jim
    25th Oct 2017
    8:50pm
    We don't need to go to the USA to find someone better than Bill, there are a few in the Labor party that would make a better leader, Alby is one that comes to mind. Unfortuanately the left wing of the Labor party have placed all their hopes on Bill, this despicable man is a traitor to the union and used the union for his own benefit, he sold the working man out I speak from experience of the duplicity of this grub, he will almost certainly be out next prime minister, we can only hope the Labor party come to their senses and get rid of him before he destroys the country.
    musicveg
    25th Oct 2017
    7:54pm
    We can afford a good health care system, this is another kick in the knee's to keep the low income people down and feed the pockets of the already rich. How many knee operations can Turnbull's income pay, or the pensions of all past prime ministers?
    pepa
    25th Oct 2017
    8:47pm
    Dear Mick, you obviously do not know what you are talking about. Who said that we got $900!
    pepa
    25th Oct 2017
    9:10pm
    Well said Dim. Nice to hear someone’s comment that isn’t biased
    MD
    25th Oct 2017
    10:03pm
    Yeh right, here we are - again - beating the same old pigskin, making a helluva ruckus in the process and for what exactly, 'the other mans grass is always greener, the sun shines brighter on the other side' ? No doubt about (most) you lot, there seems no end to the endless mud slinging, point scoring and take downs. I will agree, the greens are keener though they're little more than prostitutes for whatever cause might win them some leverage. It only seems like yesterday some of the regulars were pushing the barrow for all/any two bit independent and where is your number one man now, that one you lot would have us believe was to be our saving grace ? Maybe it's time the naysayers took another ski vacation/road trip/river cruise or simply get out and shoot the breeze, anything, to clear the mind and perhaps let in a little light whereby you might view things differently.
    The relentless degree of negativity, whinging, moaning , groaning, poor me-ism contributions seem to be dragging everyone down.
    Agreed, the political landscape - and thus the practitioners within - seems barren, devoid of life and existing in a vacuum. With the exception of course that any - other than the incumbent's are much to be preferred. Get real people, they were elected, does that make roughly half the population wrong and t'other half right ?
    Win, lose or draw, pollies of all creeds are savouring their sumptuous surroundings thanks to the gullible public - US - we put em there. Our elected reps try as best they might, you can be sure hell will freeze over before they're likely to come within coo-ee of satisfying a fraction of the folk that put em there if this site is any indication.

    Car ownership is neither a right nor govt guarantee, the use of public roads is a privilege granted to those prepared to pay all/any costs. Land area, improvements and locality will generally reflect the associated costs and if your living area is restricted then don't make friends with the elephant keeper.
    Quaks are only too happy to offer unnecessary surgical procedure - because that's what their patient wants, particularly when public health foots the bill and aging patients kid themselves they're going to be bouncing around again - like it was in the good ole days.

    Quality of life is largely a matter of personal interpretation but for those of us enjoying the benefit of social largesse it brings associated limitations.
    As someone mentioned earlier - 'such is life'.
    Fairness
    26th Oct 2017
    12:14am
    Seem to recall attacking kneecaps was reminiscent of war years....... suppose there could be happenings in future.....
    mogo51
    26th Oct 2017
    1:40pm
    Would it not be more simple to put a tax on electric cars also? Dehhh!
    Blossom
    26th Oct 2017
    8:10pm
    Defunding minor knee surgery is going to lead to a lot more expensive cases of major knee surgery in the future. Removing minor damage that arthritis is causing reduces significantly the need for financial assistance for people who physically cannot work because of painful weak knees which struggle to support people when they are walking. Eventually the only viable option is knee replacement surgery with months of intensive physiotherapy and a high likelihood of sickness benefits needed to support people during recovery OR even Disability Support Pension. Having limited or no use of one knee puts huge pressure on the other one. If you have to continuously treat the second one it becomes a vicious circle. I know of 2 such cases where eventually a guy has been forced to have reconstruction of both knees due to an accident which was his fault. One will defintely need to be replaced again because of his age when it was done. The same thing may occur with the other knee if he isn't forced to retire because of it.
    Blossom
    26th Oct 2017
    8:14pm
    As far as I know people who own more than one property are already paying land tax. Yes they can earn an income from them but most only cover general expenses, not make a good profit from them. It provides housing for others unitl they can afford to buy a house of their own. There is a shortage of housing rental and the Govt. in SA has sold off a lot or in some cases has left them empty.
    toot2000
    27th Oct 2017
    10:16am
    Arthroscopic debridement, specifically, involves using surgical instruments to remove damaged cartilage or bone. The surgeon typically does a washout or joint lavage to remove any debris around the affected joint. If loose bodies or fragments remain after the lavage, they are removed.

    ….The Bottom Line
    The American Academy of Orthopaedic Surgeons (AAOS), incorporated the conclusions into their treatment guidelines for knee osteoarthritis. The AAOS states that arthroscopic debridement, when performed on patients with primary osteoarthritis symptoms and x-ray or MRI evidence of joint space narrowing, offer no benefit beyond what physical therapy and nonsteroidal anti-inflammatory drugs (NSAIDs) can provide.
    https://www.verywell.com/arthroscopic-debridement-of-knee-2552241
    Bulla
    22nd Nov 2017
    1:09pm
    Of course, except like of him as they can always plead that their knees are broken and also backbone because of bending too much before everyone and electorate so often and MUST in addition be paid special allowance