Commission of Audit calls for a 'digital by default' strategy

The national Commission of Audit (CoA) has recommended that Australia follow the UK and implement a “digital by default” strategy for citizen access to government services, with the Department of Human Services' myGov site as the “centrepiece of an aggressive new approach”.

The Commission's most controversial proposals, for a $15 upfront fee to see a GP and a recommendation that state governments consider the same for triage categories 4 and 5 in public hospital emergency departments, have already been widely criticised by healthcare groups and are likely to face fierce resistance.

AMA president Steve Hambleton blasted the recommendations, saying it was “clear that the Commission’s recommendations have been put forward by business leaders and bureaucrats with no input from people with health and medical expertise”.

“It is a health system designed by bean counters for bean counters,” Dr Hambleton said. “It puts saving money ahead of saving lives. The co-payment would also burden general practice with extra red tape, which is contrary to stated government policy.”

The report recommends that GPs be barred from waiving the fee, but does not provide any detail on how the fee collection will be administered, or the effect it will have on the current system of Medicare rebates.

The report does not make any recommendations on eHealth, but does recommend that myGov, which is the online entry point to Medicare and the PCEHR as well as the DVA, Centrelink and in future the Australian Taxation Office, be used as an opt-out system for much of the day-to-day transactions between citizens, businesses and government departments.

The Commission says myGov has around two million registered members and is accessed by over 150,000 users each week, with a further two million users anticipated to register by mid 2014 as the ATO begins to use it. The Commission recommends that the government accelerate the transition to online service delivery by making myGov the default means of engaging with government, supported by opt-out provisions.

It also recommends that the government consolidate the eGovernment effort through a single team under the leadership of a chief digital officer, and appoint a senior minister to champion the digital by default agenda.

The CoA says the myGov online credential will need strengthening, and that the department's rapidly ageing information management system will need to be replaced. As part of its wide-ranging privatisation and outsourcing recommendations, the Commission says it supports the replacement of the system, but that the government also consider completely outsourcing government payments, including Medicare.

“In 2012, 50 per cent of services provided by the Department of Human Services were not conducted online,” the CoA report says. “The growing awareness and popularity of myGov offers the potential for significant change in Australia.

“The Commonwealth government has made a commitment to ensure every government interaction that occurs more than 50,000 times per year can be undertaken online by 2017. It will also aim to make all government correspondence available digitally by 2017. The Commission considers government should do better than that.”

It says the government should adopt a “transformative strategy to become digital by default” for all transactions and should “act decisively to remove legislative barriers to digital transactions”.

“It should set concrete milestones, including switching from an ‘opt-in’ arrangement for myGov to a default ‘opt-out’.

“The strategy should require agencies to make services available through mobile applications. It should have clear and ambitious timelines. It should aim to simplify departmental processes – there is limited value in collecting electronic information from citizens to feed into manual processes in departments.

“The strategy should also strengthen the myGov online credential. This could be done through the addition of face-to-face verification or biometric information. It would result in a credential that could be used to prove identity in both the public and private sectors.”

The Commission has also recommended that the government open up the untapped potential of anonymised data and new data analytic techniques to improve the efficiency and effectiveness of government.

This includes medical data it already holds through the PBS, MBS and Medicare, as well as welfare and social data.

In addition to the recommended GP fee, one of the other most controversial elements is the Commission's recommendations for the PBS. It wants the government to increase PBS co-payments by $5, from $36.90 to $41.90 for general patients and from $6 to $11 for those above the safety net.

Another recommendation certain to face fierce resistance is that the government open up the pharmacy sector to competition, including through the deregulation of ownership and location rules.

This has been swooped on by the Pharmacy Guild, which issued a statement saying it “completely rejects the recommendations” of the CoA in relation to community pharmacy.

“The Commission’s recommendations in relation to community pharmacy and the Pharmaceutical Benefits Scheme are a litany of economic rationalist ideas,” the Guild said.

Posted in Australian eHealth

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