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Australia: Opposition woos doctors
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doctors would be prepared to pay, and from national support public health systems will be essential. The aim will be to provide a service with an annual subscription rate of less than 300 ecu ([200, Ffr2000), but the cost will largely depend on the number of subscriptions taken out. most
European
The VALIDATA research group is J.-P. B. and Jennifer Cogan-Collet (Lyon); Luc Blondell, Jean-Marc Kaufman, and Marc Bogaert (Gent); Karl Uberla and Dorothy Dickson (Munich); Patrice Girard (Paris); Gianni Tognoni (Milan); Jacobus Lubsen (Rotterdam).
Clinical Pharmacology Unit, 162 avenue Lacassagne, 69424 Lyon, France
Australia:
Jean-Pierre Boissel, on
behalf of the VALIDATA group
Opposition woos doctors
Medicare will end bulk-billing, Australians will be allowed tax benefits for buying private health insurance (and in some cases suffer tax penalties for not buying it), and rebates for doctors will be tied to fees agreed with the Australian Medical Association, if the opposition LiberalNational Party Coalition wins the national election due in 1993.
The Opposition’s promises for the health sector were part of their election policy centring on the introduction of a goods and services tax (GST) very similar to the UK’s value added tax (VAT) but including specific policies for other areas of the economy. However, to the relief of doctors and patients, health services are among the few areas to be exempt from the GST. And general practitioners staggering under the Medicare rebate reductions that came into effect on Dec 1 will be especially inclined to look favourably on the proposed changes because they promise the private sector a far greater role in health-care provision and may raise GP incomes. Bulk-billing will end for all but pensioners, veterans, war widows, health-care card-holders, and the disabled (about four million people in all). Fees for these patients seen outside hospital will continue to be rebated at 85% of the Medicare Benefits Schedule (MBS) fee, but the Medicare rebate for other categories of patients will be cut to 75%. However, the Government’s monopoly on insurance for medical services will be ended, and private health insurers will be permitted to insure patients for the gap between the money rebated by Medicare and the doctor’s fee. This should allow the general level of fees to rise, but patients will still pay part because the level of gap insurance will be limited to 85% of a fee negotiated between private health insurers and the AMA. The opposition has sweetened this pill by promising that no one will pay a gap of more than$30 per medical service. The new emphasis on private insurance includes a carrot-and-stick arrangement aimed at encouraging individuals to insure themselves. Low-income families who take out private insurance will receive tax credits of from $200 to$400 a year ($400 to$800 if they are over 65 years old), but families with incomes over$50 000 a year will pay a tax surcharge of$800 if they do not take private insurance and choose to depend solely on Medicare. Opposition health spokesman, Dr Bob Woods, said his party’s policy would get rid of hospital waiting lists by encouraging greater use of private hospitals and forcing well-off patients who use Medicare out of the public hospital system. He also promised that the coalition would restructure the Medicare Benefits Schedulc to give GPs incentives to practise preventive medicine and to provide
sizeable additional funds for mobile breast cancer screening and bone-density measurements. The Government has stumbled seriously in its attempts to attack the whole GST package, and health has been no exception. Minister for Health, Housing, and Community Services, Mr Brian Howe, issued a press release claiming that the coalition planned to penalise anyone who did not take out private insurance, a statement that was clearly wrong and that he had to withdraw at a press conference meant to mount a damaging attack on the policy. Since that time the Government has been pushing the line that opening the way to greater use of private insurance will drive the cost of medicine in Australia to levels comparable with those in the US (around 12% of GDP), but it has presented no hard evidence for this claim. Its overall attack on the coalition’s proposals has been so bumbling that Prime Minister Bob Hawke has been forced to sack his Treasurer of a mere six months’ standing, Mr John Kerin, and that he may soon lose his job himself.
speculation is rife Nick Lush
Conference Tissue banks in Europe The 1st European Conference on Problems of Tissue Banking and Clinical Applications, held in Berlin on Oct 24-26, was a landmark in the development of the subject. In the USA, regional tissue banks, validated by the American Association of Tissue Banks, have proved indispensable to surgeons, and Dr Hans Burchard, director of the Pennsylvania bank, reported that over 300 000 musculoskeletal grafts are transplanted annually in that country. Eastern European tissue banks are now able to illustrate their pre-eminence in this specialty-indeed the conference venue was the famous Humboldt University Medical School (Charite), which has had a tissue bank for 35 years, supplying 50 000 bone grafts to more than 250 hospitals. In 1990, of more than 8000 grafts supplied from 600 donors, 64% were bone. Equally productive tissue banks have been operating in Czechoslovakia, Poland, and the Soviet Union. Over this period, techniques have been devised for the safe procurement, processing, sterilisation, and distribution of allografts, and much has been learned about the functional characteristics that must be preserved during these procedures if grafts are to perform effectively. Prof V. 1. Saveliev (Leningrad) described the 30 years of tissue bank practice. Clearly the liberal laws governing the procurement of human tissue in Eastern Europe and the Soviet Union have contributed greatly to the progress in these European countries but such a climate is not essential to the steady supply of tissues. For example, the Organ Procurement Agency of Michigan is now in its second year of a collaboration with the Michigan Eye Bank and Transplantation Center (the State’s oldest not-for-profit anatomical gift programmes) and the Musculoskeletal Transplant Foundation, the largest centralised tissue organisation in the USA. The primary goal is to coordinate the process of donating organs, eyes, bones, skin, and other tissues; to improve the quality of the donated material; and to increase the size of the donor pool. Bone procurement during 1990 was four times the 1989 level and skin procurements more than doubled. The British contribution to the Berlin conference was noteworthy for its absence. Except for the multi-tissue Yorkshire Regional Tissue Bank, the emerging tissue banks in Leicester and North Wales, and sporadic activities in orthopaedic centres such as Nottingham, there is little movement to establish multi-tissue banks
doctors would be prepared to pay, and from national support public health systems will be essential. The aim will be to provide a service with an annual subscription rate of less than 300 ecu ([200, Ffr2000), but the cost will largely depend on the number of subscriptions taken out. most
European
The VALIDATA research group is J.-P. B. and Jennifer Cogan-Collet (Lyon); Luc Blondell, Jean-Marc Kaufman, and Marc Bogaert (Gent); Karl Uberla and Dorothy Dickson (Munich); Patrice Girard (Paris); Gianni Tognoni (Milan); Jacobus Lubsen (Rotterdam).
Clinical Pharmacology Unit, 162 avenue Lacassagne, 69424 Lyon, France
Australia:
Jean-Pierre Boissel, on
behalf of the VALIDATA group
Opposition woos doctors
Medicare will end bulk-billing, Australians will be allowed tax benefits for buying private health insurance (and in some cases suffer tax penalties for not buying it), and rebates for doctors will be tied to fees agreed with the Australian Medical Association, if the opposition LiberalNational Party Coalition wins the national election due in 1993.
The Opposition’s promises for the health sector were part of their election policy centring on the introduction of a goods and services tax (GST) very similar to the UK’s value added tax (VAT) but including specific policies for other areas of the economy. However, to the relief of doctors and patients, health services are among the few areas to be exempt from the GST. And general practitioners staggering under the Medicare rebate reductions that came into effect on Dec 1 will be especially inclined to look favourably on the proposed changes because they promise the private sector a far greater role in health-care provision and may raise GP incomes. Bulk-billing will end for all but pensioners, veterans, war widows, health-care card-holders, and the disabled (about four million people in all). Fees for these patients seen outside hospital will continue to be rebated at 85% of the Medicare Benefits Schedule (MBS) fee, but the Medicare rebate for other categories of patients will be cut to 75%. However, the Government’s monopoly on insurance for medical services will be ended, and private health insurers will be permitted to insure patients for the gap between the money rebated by Medicare and the doctor’s fee. This should allow the general level of fees to rise, but patients will still pay part because the level of gap insurance will be limited to 85% of a fee negotiated between private health insurers and the AMA. The opposition has sweetened this pill by promising that no one will pay a gap of more than$30 per medical service. The new emphasis on private insurance includes a carrot-and-stick arrangement aimed at encouraging individuals to insure themselves. Low-income families who take out private insurance will receive tax credits of from $200 to$400 a year ($400 to$800 if they are over 65 years old), but families with incomes over$50 000 a year will pay a tax surcharge of$800 if they do not take private insurance and choose to depend solely on Medicare. Opposition health spokesman, Dr Bob Woods, said his party’s policy would get rid of hospital waiting lists by encouraging greater use of private hospitals and forcing well-off patients who use Medicare out of the public hospital system. He also promised that the coalition would restructure the Medicare Benefits Schedulc to give GPs incentives to practise preventive medicine and to provide
sizeable additional funds for mobile breast cancer screening and bone-density measurements. The Government has stumbled seriously in its attempts to attack the whole GST package, and health has been no exception. Minister for Health, Housing, and Community Services, Mr Brian Howe, issued a press release claiming that the coalition planned to penalise anyone who did not take out private insurance, a statement that was clearly wrong and that he had to withdraw at a press conference meant to mount a damaging attack on the policy. Since that time the Government has been pushing the line that opening the way to greater use of private insurance will drive the cost of medicine in Australia to levels comparable with those in the US (around 12% of GDP), but it has presented no hard evidence for this claim. Its overall attack on the coalition’s proposals has been so bumbling that Prime Minister Bob Hawke has been forced to sack his Treasurer of a mere six months’ standing, Mr John Kerin, and that he may soon lose his job himself.
speculation is rife Nick Lush
Conference Tissue banks in Europe The 1st European Conference on Problems of Tissue Banking and Clinical Applications, held in Berlin on Oct 24-26, was a landmark in the development of the subject. In the USA, regional tissue banks, validated by the American Association of Tissue Banks, have proved indispensable to surgeons, and Dr Hans Burchard, director of the Pennsylvania bank, reported that over 300 000 musculoskeletal grafts are transplanted annually in that country. Eastern European tissue banks are now able to illustrate their pre-eminence in this specialty-indeed the conference venue was the famous Humboldt University Medical School (Charite), which has had a tissue bank for 35 years, supplying 50 000 bone grafts to more than 250 hospitals. In 1990, of more than 8000 grafts supplied from 600 donors, 64% were bone. Equally productive tissue banks have been operating in Czechoslovakia, Poland, and the Soviet Union. Over this period, techniques have been devised for the safe procurement, processing, sterilisation, and distribution of allografts, and much has been learned about the functional characteristics that must be preserved during these procedures if grafts are to perform effectively. Prof V. 1. Saveliev (Leningrad) described the 30 years of tissue bank practice. Clearly the liberal laws governing the procurement of human tissue in Eastern Europe and the Soviet Union have contributed greatly to the progress in these European countries but such a climate is not essential to the steady supply of tissues. For example, the Organ Procurement Agency of Michigan is now in its second year of a collaboration with the Michigan Eye Bank and Transplantation Center (the State’s oldest not-for-profit anatomical gift programmes) and the Musculoskeletal Transplant Foundation, the largest centralised tissue organisation in the USA. The primary goal is to coordinate the process of donating organs, eyes, bones, skin, and other tissues; to improve the quality of the donated material; and to increase the size of the donor pool. Bone procurement during 1990 was four times the 1989 level and skin procurements more than doubled. The British contribution to the Berlin conference was noteworthy for its absence. Except for the multi-tissue Yorkshire Regional Tissue Bank, the emerging tissue banks in Leicester and North Wales, and sporadic activities in orthopaedic centres such as Nottingham, there is little movement to establish multi-tissue banks