Why reforming health care is integral for our economy



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Healthcare is becoming increasingly important in a services-led economy.
Shutterstock

Michael Woods, University of Technology Sydney

Australia’s productivity growth has been stagnant for over a decade and, according to a new report, our health policies and programs could be partly to blame. Released today, the Productivity Commission report also highlights how the health-care sector (among others) could play a starring role in improving productivity.

The commission has offered a short list of thematic directions for reform. In health these include eliminating low-value services that have uncertain clinical impacts, changing the way services are delivered to focus more on the patient, and moving away from a community pharmacy model to more automatic dispensing in a greater range of more convenient locations.

The underlying message is that productivity growth is essential if Australia is to expand its economy, generate opportunities for real income growth and raise community living standards.

But as a Productivity Commission discussion paper released last November noted, there is a justified global anxiety that growth in productivity — and in income and well-being, which are inextricably linked to it over the longer term — has slowed or stopped. Across the OECD, growth in GDP per hour worked was lower in the decade to 2016 than in any decade from 1950.

The commission notes that labour productivity has been rising, but that has more to do with greater capital investment than more efficient workforce practices.

The report also highlights a change in thought about productivity. The emphasis has shifted from the need to produce goods more cheaply to improving our human capital – the knowledge, skills and work practices of our community – and delivering more efficient and effective health, education and related services.

The change recognises that Australia is now predominantly a service economy, that health care is a significant economic service, and that the productivity of our workforce, including its health, needs to underpin our economic growth.

The health sector is big and still growing

The health sector is a big part of our economy and still growing as a proportion of our overall economy. By 2016, according to the OECD, it accounted for 9.6% of our total gross domestic product.

This is similar to that of New Zealand and the United Kingdom, less than Canada and far less than the United States – which is an international outlier at over 17% of its total domestic output. Add aged care and disability services, and the commission puts the figure at 13% of Australia’s GDP.

We continue to spend ever more on health, in real (inflation-adjusted) terms, both as taxpayers and as consumers. But are we getting good value for our money? An inefficient health system, wrongly priced services and poorly designed system incentives all drag on the cost of health care and on the productivity of a very large sector of the economy.

A decade ago, the health-care and social-assistance sector employed nearly 1.07 million people. This was a little less than retailing (1.21 million) and a little more than manufacturing (1.03 million). The health sector employed 10.3% of the Australian workforce.

Fast forward to 2017 and retail employment has stayed relatively stable at 1.26 million and manufacturing has declined to 0.9 million. In contrast, health care and social assistance has risen to 1.64 million – 13.3% of total employment.

Any opportunity to increase the efficiency of the health workforce will translate directly to greater labour productivity for the economy as a whole. And its effectiveness can be improved, in part by education and training, which improves the skills of our doctors, nurses, allied health workers and others to work collaboratively to deliver patient-centred care. This is the subject of an independent review for the COAG Health Council by this article’s author.

The actual productivity of the health workforce, unfortunately, is notoriously hard to measure. This is due in no small part to the lack of market forces and to wage costs that are often negotiated between unions and their employers – the governments.

The Productivity Commission’s forthcoming report on improving markets and competition in health and other human services will hopefully offer useful guidance on what reforms are needed in some of these sectors.

Workforce health is an important part of our human capital

A third role for a more efficient and effective health sector is to contribute to improving the health of the workforce overall. Education and health are recognised as the two most significant building blocks of human capital. Making the most of our human capital is a central message of the OECD’s research on productivity.

There is also ample evidence, including in the new Productivity Commission report, that poor health leads to poor labour market outcomes. A 2013 study into disadvantage in Australia concluded that people with long-term health conditions are likely to experience deep and persistent disadvantage, but, equally, disadvantage can lead to poor health.

Back to the future

The challenge remains to reform the health system, and its workforce in particular, so that practitioners, administrators and others have the skills, knowledge and professional attributes to meet the emerging health-care needs of our community.

As the Australian Institute of Health and Welfare points out in its latest review of Australia’s health, the community’s burden of disease is changing. There is now a greater need for longer-term integrated care to deliver services for those with chronic diseases, the elderly, those with dementia, disability and poor mental health, and to provide services to those in rural areas and remote communities.

The message in this latest report is welcome, but unfortunately it is not entirely new. A Productivity Commission report over a decade ago made the point that Australia’s growth potential will depend increasingly on making the best use of our human capital.

One of the aspirations at that time was for an agreed agenda of integrated health services reform within a national framework. It was seen as a way of adding much-needed impetus to overcoming long-standing structural problems that prevented the health-care system from performing to its potential.

The ConversationLittle progress has been made since then. Hence this report is important in reinforcing the message that the next big gains in productivity will need to come from reforming the delivery of health and education. Let’s hope the call for a shared agenda of reforms is taken up more actively than experience to date might suggest.

Michael Woods, Professor of Health Economics, University of Technology Sydney

This article was originally published on The Conversation. Read the original article.

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Prospects Dim for Religious Freedom in Nepal


Right to share faith could harm Nepal’s Hindu identity, lawmakers believe.

KATHMANDU, Nepal, March 29 (CDN) — A new constitution that Nepal’s parliament is scheduled to put into effect before May 28 may not include the right to propagate one’s faith.

The draft constitution, aimed at completing the country’s transition from a Hindu monarchy to a secular democracy, contains provisions in its “religious freedom” section that prohibit anyone from converting others from one religion to another.

Most political leaders in the Himalayan country seemed unaware of how this prohibition would curb religious freedom.

“Nepal will be a secular state – there is no other way,” said Sushil Koirala, president of the Nepali Congress, Nepal’s “Grand Old Party,” but he added that he was not aware of the proposal to restrict the right to evangelism.

“Forcible conversions cannot be allowed, but the members of the Constituent Assembly [acting parliament] should be made aware of [the evangelism ban’s] implications,” Koirala, a veteran and one of the most influential politicians of the country, told Compass.

Gagan Thapa, another leader of the Nepali Congress, admitted that banning all evangelistic activities could lead to undue restrictions.

“Perhaps, the words, ‘force, inducement and coercion’ should be inserted to prevent only unlawful conversions,” he told Compass.

Man Bahadur Bishwakarma, also from the Nepali Congress, said that of all the faith communities in Nepal, Christians were most active in converting others, sometimes unethically.

“There are problems in Hinduism, such as the caste hierarchy, but that doesn’t mean you should convert out of it,” he said. “I believe in reforming one’s religion.”

Asked if the restriction on converting others violated the International Covenant on Civil and Political Rights (ICCPR), Akal Bahadur of the Unified Communist Party of Nepal (Maoist) said, “It may, but there was a general consensus on it [the prohibition]. Besides, it is still a draft, not the final constitution.”

Nepal signed the ICCPR on May 14, 1991. Article 18 of the ICCPR includes the right to manifest one’s religion, which U.N. officials have interpreted as the right to evangelistic and missionary activities.

Akal Bahadur and Thapa are members of the Committee on Fundamental Rights and Directive Principles, which was tasked to propose the scope of religious freedom and other rights in the draft constitution. This committee, one of 11 thematic panels, last year submitted a preliminary draft to the Assembly suggesting that a person should be allowed to decide whether to convert from one religion to another, but that no one should convert anyone else.

Binda Pandey, chairperson of the fundamental rights committee and member of the Communist Party of Nepal (Unified Marxist Leninist), told Compass that it was now up to the Assembly to decide whether this provision violates religious freedom.

The Constitution Committee is condensing the preliminary drafts by all the committees as one draft constitution. At least 288 contentious issues arose out of the 11 committees, and the Constitution Committee has resolved 175 of them, Raju Shakya of the Kathmandu-based Centre for Constitutional Dialogue (CCD) told Compass.

The “religious freedom” provision with its ban on evangelism did not raise an eyebrow, however, as it is among the issues listed under the “Area of Agreement” on the CCD Web site.

Once compiled, the draft constitution will be subject to a public consultation, after which another draft will be prepared for discussion of clauses in the Constitutional Assembly; provisions will be implemented on a two-thirds majority, Shakya said.

 

Hindu Identity

Thapa of the fundamental rights committee indicated that religious conversion could become a contentious issue if the proposed restriction is removed. Even the notion of a secular state is not wholly accepted in the country.

“If you hold a referendum on whether Nepal should become a secular state, the majority will vote against it,” Thapa said.

Most Hindus see their religion as an essential part of the country’s identity that they want to preserve, he added.

Dr. K.B. Rokaya, the only Christian member of Nepal’s National Commission for Human Rights, said Nepal’s former kings created and imposed a Hindu identity for around 240 years because it suited them; under the Hindu ethos, a king should be revered as a god. Most of the numerous Hindu temples of Nepal were built under the patronage of the kings.

Rokaya added that Christians needed to be more politically active. The Assembly does not have even one Christian member.

According to the 2001 census, over 80 percent of Nepal’s 30 million people are Hindu. Christians are officially .5 percent, but their actual number is believed to be much higher.

Nepal was the world’s only Hindu kingdom until 2006, when a people’s movement led by former Maoist guerrillas and supported by political parties, including the Nepali Congress and the Unified Marxist Leninist, ousted King Gyanendra.

An interim constitution was enacted in 2007, and the Constituent Assembly was elected through Nepal’s first fully democratic election a year later. The Assembly was supposed to promulgate a new constitution by May 28, 2010, but its term was extended by one year.

It is still uncertain, however, whether the approaching deadline will be met due to persistent disagreements among parties. The Maoist party has 220 members, the Nepali Congress 110, and the Unified Marxist Leninist 103 in the 575-member Assembly.

Rokaya, a member of the newly formed United Christians Alliance of Nepal, comprising a majority of Christian denominations, said Christians would continue to ask for full religious freedom. The use of inducement or force for conversions is deplorable, but the right to preach the tenets of one’s religion is a fundamental freedom, he added.

Report from Compass Direct News
http://www.compassdirect.org

LUTHERANS MIGHT ALLOW PASTORS TO BE IN HOMOSEXUAL RELATIONSHIPS


The Evangelical Lutheran Church in America released proposals Thursday, Feb. 19, that seek to change Christian teaching on homosexuality and would permit pastors to be in same-sex sexual relationships, reports LifeSiteNews.com.

In response, leaders of Lutheran CORE (Coalition for Reform) announced Thursday that they will work to defeat the proposals that ask the ELCA to depart from biblical teaching on sexuality.

Lutheran CORE is a coalition of pastors, lay people, congregations and reforming groups that seeks to preserve the authority of the Bible in the ELCA.

“These recommendations mark a significant departure from the church’s commitment to Scripture as the source and norm of its faith and life,” said the Rev. Paull Spring of State College, Pa., chair of the Lutheran CORE Steering Committee.

“The proposal for change in standards for clergy departs from the clear teaching of Scripture,” said Spring, the retired bishop of the Northwestern Pennsylvania Synod.

Responses to a 2004 study on homosexuality showed that a significant majority of ELCA members (57 percent) opposed change to accepted Christian teaching on homosexual behavior. Only 22 percent of ELCA members favored change in church teaching to allow for the blessing of same-sex unions or the ordination of practicing homosexuals.

Report from the Christian Telegraph

NECESSITY OF REFORMING THE CHURCH: John Calvin


This classic work by the Reformer John Calvin is available on the particularbaptist.com web site at:

http://particularbaptist.com/library/calvin_necessity.html

LORD’S SUPPER SERIES: 1. THE INSTITUTION OF THE LORD’S SUPPER – 1 Corinthians 11:23-26


Please Read 1 Corinthians 11

This morning we turn our attention to the Lord’s Supper, this being the day on which we come together as a church to actually celebrate the Lord’s Supper together.

I do not know what your experience of past Lord’s Supper’s has been, but I do know what mine have been like, and I have been far from satisfied with what has been practiced on most occasions.

Often times the Supper is tacked onto the end of a service, as though it were a necessary evil that we have to go through in order to do things right. Generally speaking it seems to be celebrated as an empty ritual, with many people just going through the motions, even relieved when it is over.

As a reforming church, it is important for us to consider the Lord’s Supper and to see whether our approach to it is in need of a change. Are we measuring up to the Biblical Lord’s Supper, or are we pursuing something that is merely a traditional way of doing things?

John Calvin in his commentary on this portion of Scripture says,

‘This passage ought to be carefully studied, for it shows that the only remedy for removing and correcting corruptions is to get back to the unadulterated institution of God.’

And this is our aim here in this place, to reform after the pattern of scripture, and so over the course of this year we will devote ourselves to this passage which is so full of instruction concerning the Lord’s Supper. May the Lord be our Teacher, and His Word our textbook.

 

1. The Importance of Proper Form

When we come together for the Lord’s Supper are our meetings doing more harm than good? This is a question that we need to ask ourselves in all seriousness. This is something which was actually the case with the Corinthian church, ‘Now in this that I declare unto you I praise you not, that ye come together not for the better, but for the worse. (11:17).’

What a terrible indictment for a church! We need to be sure that this is not the case with us, so we need to examine this passage this morning to see what it has to tell us as regards the way we ought to observe this Supper.

The first thing that strikes the reader of this passage is the importance of proper form. Today we find ourselves in a religious climate in which the form of the Lord’s Supper can be anything, as long as the name is kept on it. It is as though it doesn’t matter what is done as long as it has a Scriptural tag, then its going to be OK.

The Supper has become an institution open to all manner of abuses, and the one which sticks out from all the rest is of course the Roman Catholic Mass, and all its idolatrous and ungodly rite.

But even the more subtle corruptions need to be addressed, for all such separations from the God-given form are sin, and a deviation from the form given by the Lord Jesus Christ.

And what about what was going on in Corinth, for ‘For this cause many are weak and sickly among you, and many sleep (11:30).’ Do you see the importance in getting this right? People were getting sick, and even being killed as punishment for their abuse of the Lord’s Supper. so you see, this is no light matter, it needs to be taken seriously.

Is there then a proper form to follow, a blueprint that we must carefully observe and stick to? The answer is yes there is, ‘For I have received of the Lord that which also I delivered unto you (11:23).’

Continued at: http://particularbaptist.com/sermons/sermonscor1.html

Reforming the Church


One of the things you would expect a Reformed Church to be doing is reforming after the Biblical model, whether they be Baptist, Presbyterian, Anglican, etc. But is this the case or have the Reformed Churches lived up to their name – Reformed? Have they already reformed enough – hence the name Reformed? This is a question that we perhaps would do well to ponder – especially if we like to regard ourselves as reformed.

As a Particular Baptist I would be classed these days as being pretty much a Reformed Baptist ~ as much as I would like to protest that I do not believe I am like many modern-day Reformed Baptists, this is still a fairly accurate description. However, I am committed to the idea of constantly reforming after the Biblical model. Now this doesn’t mean that I have to adopt 1st century music, a Grecian Bible, etc. It simply means that I would like to put into practice those principles that are outlined in the Bible as being the Biblical method of doing church, of living, etc.

Now the point of this particular posting is to do with the organisation of the church and church practice – is the modern-day reformed movement being Biblical in its approach to the organisation of the church and church practice? From my observations of the Reformed Baptist movement and those who could be loosely described as such, I would have to say, probably not. A way has been found to do things and there is great reluctance to change that way, even though the Bible would suggest that it isn’t quite right, etc. This would certainly indicate a Reformed Church in so much that it has moved from an error to a certain point and stopped – reformed. This would be like the Church of England in the days of the Reformers and Puritans. There were many men who would have liked to have had the church reform even further than it had done, but this was prevented by the powers that were then in place, hence the withdrawal of these men from the established church and the formation of other assemblies that sought to further reform after the biblical model.

We need today a new committment to one of the principles of the reformation and the reformers, a committment to be constantly reforming after the model of the Scriptures. This is simply an implication of the great reformation catch cry of ‘Sola Scriptura.’ We see what Scripture says should be the way we do things and we then set about to do it. Perhaps this should be a ‘UGR (unwritten ground rule)’ for the church, except it is written, for it is what the Scriptures would have us to do. We read and study the Scriptures, see what it says, and then we set to do it in the true spirit of ‘Sola Scriptura.’

Are we reformed (as in stopped) or are we reforming, as the name was originally seeking to suggest? In what way can we still be reforming in the modern-day reformed setting as churches with a reformed heritage?

This was one of the things we were seeking to do when the ‘Northlake’s Reformed Baptist Church (NRBC)’ was seeking to become established (sadly it is no more) – to be reforming after the model of the Scriptural way of doing things.

One of the things we sought to do was return the Lord’s Supper to the context of the fellowship meal as was the practice of the New Testament church. We would observe the Lord’s Supper as part of our fellowship together, having a meal together after a worship service on a Sunday. It was something we all looked forward to. Now there is no command for that I admit, but it was something we saw great advantages in and so we changed the way we did things and adopted the practice – it was a case of reforming after the biblical model, even though it wasn’t expressly commanded.

We also sought to learn as much as we could from the Biblical text regarding the Lord’s Supper, spending several Lord’s Days preaching through the Corinthians text relating to the Lord’s Supper and seeking to put into practice, both individually and as a church, the truths taught there. Again, an example of reforming the church instead of remaining reformed (reaching a certain point and stopping).

I am not suggesting that NRBC was the perfect model at this sort of thing, no not at all – I am simply holding up the example of NRBC as a church committed to the principle of always reforming the church after the Biblical model. I’m not convinced that we were really brilliant at the task of reforming the church, but we did seek the Lord’s will through prayer and a careful consideration of the Word of God, as well as seeking the ability from the Lord to actually put into practice what we discovered in the Word of God.

There are so many areas that we need to carefully consider again in the light of Scripture – things that have now become merely the tradition of men, rather than the tradition of the apostles (meaning after the biblical model).

When I first got onto the Internet some years ago now, I came across a site that really encouraged me and our church in this area of reforming the church. It has changed URLs once or twice since that time, but I keep returning to it. It is a site called ‘A 21st Century Puritanism,’ operated by a guy called Mitch Cervinka. Obviously what is presented needs to be carefully considered in the light of Scripture and I certainly wouldn’t agree with everything that Mitch presents, yet there is a lot that I find myself having to agree with (gladly) because it is founded on the Scriptures.

The link is:
A 21st Century Puritanism

There are two articles that I really like on the site and these are:

There are some excellent points made in these articles and they should really be considered by reformed churches in this matter of perpetually reforming the church.

THE ‘ELIJAH’ EXPERIENCE


I have now decided to start using the diary as I had before planned to do. This time I’m hoping to actually keep at it (time will tell I guess). I have now added a link to the diary from my page on the website (http://particularbaptist.com/kevins/kevin.html), which may provoke me to actually keep at it.

Here is my opportunity to share something of my spiritual journey with the world – not that I’m a great or outstanding saint in the overall scheme of things (more like one at the bottom of the pile, but that’s OK, for at least I’m in the pile). Perhaps the Lord will be pleased to use the diary as a help to someone in some way, even if it be an obscure way that I never hear about.

For the last few weeks I have been having something of an ‘Elijah’ experience. That is, the feeling of being alone in my spiritual walk and as though the church has abandoned the Lord’s way as outlined in the Scriptures. It’s a rather poor outlook I’ll admit, but essentially that’s what my problem in one sense is all about. The church in this country is in an appalling state (much like my spelling appears to be at times), having long ago abandoned the peculiar truths of our reformation heritage, not to mention our Scriptural heritage.

In my area of this country which I dearly love, I have been involved in just about all the Reformed Baptist churches so-called during the last 15 or so years. At the end of this time I find myself seemingly alone in my search for the true church. There has been all sorts of departures in my understanding of things, from a legalistic hard spirit, right through to a church beginning to embrace a more popular, user friendly approach to things. I have even pastored a church (which seems to have failed) in an attempt to raise a new standard here by way of a Biblically Reforming church – yet many have no interest in such things. Now I find myself at my wits end, waiting on the Lord to bring about some change in the spiritual landscape of this area and indeed this country – how we need a Spurgeon, a Calvin or the like here now!

I have allowed myself to despair and this has been a sin. I should have been trusting the Lord, looking unto Him rather than the chaos in the churches around about. Add to this the usual sins that afflict me and you find a Christian falling woefully short of what he should be, especially in view of the great grace and love which the Father has bestowed upon me in the Person of His Son and in the work that He has performed. May God be gracious to me – a sinner worthy of no grace or blessing from such a holy and majestic God. Yes my Redeemer lives – may he yet raise me up from my despair, for I fear and know I am incapable of delivering myself from the mire.

My only hope is my God, in whom is all grace, mercy and love