Q: Do Australians actually go to the GP 11 times a year on average? A: Not even close

Last Thursday, the National Commission of Audit, headed by the outgoing President of the Business Council of Australia,Tony Shepherd, was publicly released with much fanfare. It was immediately followed by much fear and angst due to the range and size of the cuts to many government programs it recommended. One of the most widely reported and controversial recommendations was for a $15 Medicare co-payment to be applied to GP visits, reduced to $7.50 for concession holders. After 15 visits in a year this would be reduced to $5 and $2.50 respectively. During the press conference announcing the report, Tony Shepherd justified this new charge (some including me would call it a tax) by implying Australians go to the doctor too often and that there is overservicing by GP’s in Australia.

“All Australians, on average, go to the doctor now 11 times per year. I just don’t think we’re that crook”

Some commentators such as Anne Henderson on the ABC’s current affairs discussion panel The Drum, said this was due to some going to see their GP for a ‘chat’ due to loneliness, rather than any real health needs.

Tony Shepherd repeated this claim in the Senate hearings the day after the report was released:

CHAIR (Senator Richard Di Natale): “Mr Shepherd, I have some questions about the changes to Medicare and the health system. Let me begin with the statement that I think you made yesterday where you stated that on average people saw a GP 11 times and year and I think you said, ‘Australians just aren’t that crook.’ On what evidence are you making that statement?”

Mr Shepherd : “The average is the average and we have that. That seems to me to be excessive in any layman’s look at the thing.”

Senator Di Natale then went on to press Mr. Shepherd about what evidence he had for the existence of overservicing of GP attendances. Just like in the report he provided no evidence for the figure of 11, nor of any overservicing, just a “potential risk of over servicing”. The National Commission of Audits’ Head Secretariat, Peter Crone called this notion a “judgment call”  (the full Hansard transcript is well worth a read).

Three days later, Mr. Shepherd was still making the claim on ABC’s Lateline, even giving a total number of 253 million visits:

EMMA ALBERICI: “What made you think 11 visits was too many?”

TONY SHEPHERD: “Well I use that as a bit of a throwaway line, but put it this way: there are 253 million visits a year. That’s 11 times 23. So, you know, there’s a lot of visits going on each year in our – to doctors and providers under the Medicare system.”

Mr. Shepherd did mention providers in general as well as specifically GP’s, though it wasn’t clear if these are included in the 253 million total visits he cites.

11 visits per person sounded like a pretty high number to me, so I went looking instead for the median number of GP visits rather than the average, as the average would be skewed higher by those with chronic conditions that need constant supervision by their GP’s. The median is the point where someone has 50% of Australians seeing a GP more times per year than themselves and the other 50% seeing a GP fewer times. In other words, a person at the median is exactly in the middle of the population and it is therefore often a more relevant figure to the typical Australian’s experience. However the median figure proved quite hard to find but what I did find was the following statistics in a National Health Performance Authority report from June 2013 (p33). As an aside, the NHPA is to be merged with other health bodies under the Commission of Audit’s recommendations (no. 53).

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So what’s going on here? There is simply no way the national average could be 11 while the average in Medicare Local regions range from 2.4 – 7.4. Looking through the report I couldn’t find any mention of 11 GP visits per person let alone a source for it. It seems that this number has been plucked out of thin air.

So what’s the actual number of GP visits on average per person in Australia as a whole? Turns out it is a lot lower than 11. It’s actually 5.8 and has stayed fairly steady since the early 1990’s. This number is also entirely consistent with the averages for Medicare Local regions from the NHPA’s report.

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So where could Tony Shepherd have gotten the number 11 from? Is it the number of visits to all health professionals, such as GP’s, specialists, psychologists and others? Well no, the number of medicare items for Item Group 1 ‘Professional Attendances’, during the 2012-13 financial year was 160.4 million. With Australia’s population for that year estimated by the ABS at 23.1 million, that’s an average of just 6.4 per person, once again far short of the 11 visits per person repeatedly cited by Tony Shepherd.

How about all health services in total provided by medicare, including professional attendances, pathology, scans, dental services etc?

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Here we find the average is higher than 11, it’s actually 14.8, having risen from 10 to 11 in the early 1990’s. So that can’t be where his number comes from. Maybe he is using ten year old numbers for health services and he has mixed them up with GP visit’s? That wouldn’t surprise me.

Whether the increase in this number of health services per person is due to overservicing or instead a number of other possible factors, such as increased availability of new tests and procedures for various conditions or simply greater awareness of the need to look after our health, is not clear. I would hazard a guess that it’s far more likely to be the latter, though some level of overservicing is possible. However I have yet to see any evidence for this “judgment call” other than the musings of Mr. Shepard and a few comments based on what seems to be pure ideology. Without any solid evidence of people seeing a GP unnecessarily it’s a pretty thin argument to base imposing a co-payment on Australians, even if it’s just $6, not the $15 recommended by the National Commission of Audit.

I still haven’t found an official median for the number of GP visits or health services, but the ABS does conduct a yearly survey of Australian’s who are 15 years old or more about their experiences with GP’s. Included in the questionnaire is a question on how often we see, or don’t see, a GP per year. Here’s is what they found in their latest release:

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63.5% of us see a GP 3 times per year or less, and 32.7% once per year or not at all. The median is therefore somewhere around 2 visits per person per year. This is gives us a better idea of what the typical Australian will think when they ask them selves “How often do I see my GP?”. What can also be seen from this data is that a fairly small proportion of us, somewhere in the range of 15-30%, see GP’s 5.8 times a year.

But the really important statistic here is the 0.6% (0.8% the previous year) who didn’t go see a GP when they needed to. That sounds like a small number but in a population of 18.64 million Australians 15 years old or more, that’s 112,000 people. Introducing a co-payment when seeing a GP will surely cause that number to rise. What we do know is that the earlier someone seeks treatment the less it costs taxpayers in the long run. We should not be placing more barriers to seeing a doctor, instead we should be making it easier so more people get preventative care and medical conditions are diagnosed earlier and their treatment has a better chance of being both successful and less expensive. If you want to save money, increase productivity and eliminate waste in the health system, introducing a co-payments is heading in the completely wrong direction.

Up until the last day or so this figure of 11 GP visit’s has been taken at face value by journalists and even Senators in the Committee hearings last week. Jenna Price in yesterday’s Canberra Times, picked up on this and I hope other journalists get a chance to ask Tony Shepherd what his source for the number is and why it doesn’t relate, even closely, to the official figures. Because if we are to take his and the National Commission of Audit’s recommendations, we need more than ideologically based thought bubbles to convince us of their merit.

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Wikileaks Campaign Director: Boston police ‘executed’ bombing suspect.

A week before Julian Assange formally launched his Wikileaks Party earlier this month, he had announced former President of the Australian Lawyers Alliance (ALA), Tasmanian Greg Barns to be his National Campaign Director. Barns is no stranger to politics, having been a Liberal Party staffer for many years and was Malcolm Turnbull’s Campaign Director during the failed Republican bid in 1999. He was even a lower house candidate for Liberals in the 2002 Tasmanian State elections until he was disendorsed for criticising the Liberal party’s asylum seeker policy. So it’s not really surprising to see him throwing political and legal barbs around, indeed here’s one from yesterday aimed at the Liberal Party’s Shadow Attorney-General George Brandis on the indefinite detention of asylum seekers who fail ASIO security checks:

This indefinite detention applies to asylum seekers who have been assessed as genuine refugees and furthermore who have no recourse to full rights of appeal. Only to a review that can be ignored by ASIO. A policy which abhor as much as Barns and one potentially made worse by a future Attorney-General in George Brandis. Someone I’m certainly not looking forward to holding office if the Liberals gain power as the latest polls suggest. Indeed I’m sure there are many policies Greg Barns and I would agree on, the need for drug law reform in Australia for instance. However a few hours before that tweet, in response to a retweet by journalist Amanda Meade of a BBC video showing the moments immediately prior to the capture of 19-year-old Boston marathon bombing suspect Dzhokhar Tsarnaev, Greg Barns tweeted the following:

No question mark or other qualifier, rather a statement of fact that the suspect was executed by the Boston Police and therefore the US had no respect for the rule of law. Having read multiple reports of the tragic events in Boston this week, this comment struck me  as having no real connection to the media coverage, both conventional and social, of the events in question. Barns might have been referring to Dzhokhar, but as he was still alive in hospital, this didn’t make much sense. Most likely he was referring to the death of Dzhokhar’s older brother Tamerlan, who died on Thursday night during a confrontation with Boston Police in Watertown, situated just outside of Boston proper. However this still jarred with reality, as the reporting of the events of that night could in no way be objectively seen as an ‘execution’, something Amanda Meade and myself quickly pointed out:

Barns responded a few hours later, making it clear he was referring to Tamerlan, though now claiming it was “a deliberate killing” on behalf of the police instead of an “execution”.

Barns also tried to distance his remarks from Wikileaks and Assange by labelling them as personal, which I think is a bit trite. Campaign directors of political parties must know that their remarks in public will be, and I would say should be, taken as a marker of that parties thoughts on issues. Plenty of party officials have gotten into hot water from ill-advised public statement. As they should.

Thankfully he now admitted that “execution” was the wrong word, but continued on the direction of criticising the police over the death, something he still pinned on the police. By this time he had also made another complaint about the events, this time at the celebrations by Bostonians once Dzhokhar had been captured Friday. Something which may be distasteful to some, and an act I find hard imagining myself partaking in. I don’t think its hard to imagine wanting to rejoice an end to a  horrible week of violence resulting in four deaths, over a hundred more injuries and an hours long manhunt along with gunfire and explosions and a locked down city. Without being there and feeling the emotions of such events I can’t bring myself to criticise  too harshly those who felt the need to cheer.

What’s more important in my mind is his defence of this position with the following:

Where were these high ideals of democracy and the presumption of innocence in his original tweet? Why are the bombing suspects given this privilege by Barns, but not the police officers who put themselves in harm’s way to protect others? Or does Barns only see fit to uphold these principles when it suits his politics?

Coming from a barrister of such high standing, former President of the ALA, and someone not coy about criticising others on the rule of law , these comments are nothing short of disgraceful in my opinion. Without any evidence, without any presumption of innocence he has baldly stated that police officers executed a suspect and showed no respect for the rule of law. Even his later softening of his terminology barely changes his claims. The implication that they acted improperly and outside the law remained. What law did the police officers break? On what evidence does Mr. Barns support these statements? What actions should have the police taken?

But what’s worse than all this is that Greg Barns hasn’t even bothered to check the basic facts before shooting of his mouth (or rather his keyboard). Here’s how Lesly Clark from McClatchy News on Saturday described the events of that Thursday night.

It was the Watertown’s second round with Dzhokhar Tsarnaev. The first came when he and his brother, who had allegedly shot and killed a Massachusetts Institute of Technology campus police officer, careened into the sleepy streets of Watertown in two vehicles, including a Mercedes SUV that they had carjacked.

Watertown police were able to track that car, Deveaux said, and knew what streets it was on because the carjacking victim’s cell phone was still in the vehicle. They knew they were tracking the Boston Marathon bombing suspects because they had bragged about their role to the carjacking victim, Deveaux said: “We did the Boston Marathon bombing and we killed a police officer,” the chief said the victim had quoted them as saying.

Deveaux said a Watertown officer on duty spotted the two cars at about 12:30 a.m. and called for backup. But before other officers could arrive, the brothers jumped out of the cars and opened fired. “They came out shooting,” Deveaux said.

They pair carried handguns; a rifle, which Deveaux described as a long arm, was found in the car.

The police officer, still the sole responder, reversed his car to give himself some distance from the gunfire, as several more officers pulled up.

Deveaux said a shift had just ended and two off-duty officers on their way home responded to the call. Altogether, six police officers engaged in the gunfight, Deveaux said, estimating that there were more 200 shots fired over five to 10 minutes, in addition to an uncounted number of pipe bombs and other explosives that the two men were lighting and throwing.

One of those explosives was a pressure cooker bomb similar to the ones used in the marathon bombs; Deveaux said its remains were found embedded in a car down the street. Two devices that didn’t explode were also found, he said.

“How the Watertown police aren’t attending a funeral of our own based on what happened on that street over that period of time is just talent, guts and glory that my officers did,” Deveaux said.

He said the gunfight was largely over by the time “the whole greater Boston area” was arriving to help, though one of the earliest to arrive, a Metropolitan Boston Transit Authority officer, was seriously wounded.

Deveaux offered an almost cinematic description of Tamerlan Tsarnaev’s final moments. He said the 26-year-old amateur boxer had begun walking down the street, firing at the Watertown police, when he ran out of ammunition. A Watertown officer tackled him, and police began to handcuff him.

But Deveaux said his officers suddenly saw the carjacked car aimed at them and dived out of the way. That’s when the younger Tsarnaev ran over his brother and dragged him “a short distance down the street.”

So not only did the two suspects fire on police with handguns and a rifle, as well as set off explosive devices, all quite clearly justifying the use of deadly force, Tamerlan was not even killed by the police. He was killed by his brother’s attempt to use the stolen SUV to escape while further maiming police officers, which resulted in him running over his brother. A brother who had been tackled to the ground by police when he had run out of ammunition and was being handcuffed. Actions taken by police despite explosives being found on the body. The police had in fact subdued the suspect despite the violent events, and would have taken him into custody had it not been for the actions of Dzhokhar. Hardly a case of excessive force, let alone a ‘deliberate killing’. Any suggestion of ‘execution’ is downright ridiculous.

Is this what we are to expect from the Wikileaks Party campaign? Hyperbole, jumping to unsubstantiated conclusions based on nothing more than a political agenda and an axe to grind?

I think it may well be.

UPDATE April 22 6:09pm

Greg Barns replied to me on twitter this morning, though due to him misspelling my twitter handle I didn’t see it until this afternoon. Here is his comment and my responses:

As I said to him, I think his ‘personal views’ defence doesn’t cut it. He is the National Campaign Director for the Wikileaks Party. His statements in the public sphere while he is employed in that role certainly will and indeed should be seen in that light. Especially when he uses his tweeter handle for party matters:

Barns then went on to make what I think is a quite stunning denial:

Going back to his original tweet, it’s very clear that he did indeed make very serious claims of criminal activity by Police, without any evidence at all. Completely unsubstantiated.

He can dance all he wants and evade taking real responsibility, but it’s there for all to see.