Everyone is feeling the impact of increasing complexity with regard to
benefits of various sorts. I think this is a major issue in general
practice and getting worse.
Every time there is a benefit of some sort which is not available to
everyone , there has to be a process of selecting those who are
eligible, and enforcing this process.
DVA is an example of a entire bureaucracy set up for no other purpose
than enforcing a myriad of rules regarding various benefits that have
evolved willy-nilly over the last 100 years or so. Unfortunately much of
the cost of enforcing these rules falls on people outside the
bureaucracy. New rules and obligations are constantly being imposed,
usually without consultation or payment for the extra work. It would
probably be cheaper to disband the whole system and just give veterans
anything they like
This particular impost is yet another one which will probably have
little impact on PBS costs, and certainly no benefit as far as health is
concerned. It will certainly be a cost to those having to administer it.
In general, the simpler the benefit, the less there is a marginal
"bureaucratic cost". Ideally all benefits should be available to anyone
without limitation, or not available at all.
If there is to be restriction of a benefit to a particular group, then
the cost of enforcing this should be borne by govt, and be factored into
the cost of the benefit as a whole.
Richard
Ken Harvey wrote:
Elizabeth Dodd wrote:
That's what Regulation 24 is for.
From AusPharmList ....
----------
... We've been doing a survey since early this year on the 20-day rule
in our outback pharmacy. Our brief deomographics are: Population 4500
or so spread over an area the size of a medium sized European country,
generally LSE with some genuine poverty, 40% Aboriginal, 100,000+ grey
nomads and other visitors passing through each year stopping on
average "one-point-something" days in our town. We have become very
strict about the 20 day rule and believe we're doing as well as anyone
in eliminating 'illegitimate' 20-day breaches which means that we're
sure that most hoarding is confined to supplies at greater than 20 day
but less than 30 day dispense intervals.
Our survey results: We do approx 35000 PBS scripts a year - that's
600+ per week of which 57 per week (approx 9%) are <20 days and
require "Immediate Supply Required (ISR)" endorsement.
Around 40% of these 'ISR' scripts are due to simple dosage:quantity
anomalies e.g. Coversyl 2mg 1 bd m30 5R
Almost as many again are due to access problems, including: remote
dwellers who get to town only infrequently (e.g. 5 or 6 times a year)
and get their dispensing done 'opportunistically'; pensioners and
concessionals who might get their scripts done at say 18 days on
pension day "because I won't have any money again until next pension
day"; tourists who have left medication behind; people who are 'going
bush' for extended periods for work or recreation; access problems
related to disability; etc.
A further 10% are due to Irwin's 'pack ahead' DACs The remaining ones
are "miscellaneous" and will no doubt include quite a few where
despite our best efforts we get 'conned' by the patient.
But the key finding is that there are 50+ scripts per week that are
fair-and-square 'legitimate' 20DR breaches, where the pharmacist can
initial the "Immediate Supply Required" with absolute confidence.
We've also identified our "genuine hoarders" (GHs - about 15 of them)
and have worked out that over the course of a year they 'legally' get
away with around 16 extra scripts each at a cost to the govt. of about
$34 each. Thats 240 scripts (0.68% of total annual PBS volume)
totalling $8160 (1.1% of total annual govt. claimable). Wish we could
do something about it but it's practically impossible as listers will
well know.
Incidentally, these 'GHs' are in 'equilibrium hoarding state' which is
to say that most of what they hoard in 2005 will be used in early 2006
with true wastage occuring only with regimen changes, expired drugs
and death.
Even so, if our 240/$8160 p.a. is extrapolatable (if "extraoplatable"
is a word!) to 'pharmacy at large', these are significant potential
savings, but not earth shattering. But also bear in mind that THIS
hoarding is NOT in breach of the 20-day rule. We reckon breach of the
20DR for hoarding purposes is (in our pharmacy) actually quite less
and so the potential savings are quite less, . . . .
. . . UNLESS HOWEVER the govt. regards our 50+ per week LEGITIMATE
20DR breaches (dose:quantity anomalies, access problems, pack ahead
DACs, etc.) as potential savings.
Mmmmmmmmmm!
Let's hope that the instruments chosen to reduce hoarding aren't so
blunt as to penalise the innocent or cause such collateral damage &
costs as to wipe out any benefit gained
---
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