The Proposed $5 fee to visit GPs/Emergency Rooms

[Pessimistic]

I not that in SRP this thread is much smaller than those carrying on about the flood levy

Bias perhaps ?

 

[Pessimistic]

Simplest way to reduce unnecessary GP visits, would be to remove the requirement for employees to provide medical certificates every time they have a couple of days off for a cold.

I cant like this enough, plus an increasing requirement from government and other organizations to require doctors certificates to prove non attendance ie victorian schools under the libs

If you know a condition needs time not treatment, whats the point of going to the doctors where theres other bugs to catch with your lowered immune response ?

 

[medusala]

Pess, what is the current requirement? IIRC in my time in sun at DVA it was a week without a certificate.

Public sector absenteeism has typically been substantially worse than the private sector so its not hard to see why changes were made.

A bank in the UK came up with an interesting response to that. They had a scoring system ie 5 times one day absence was far worse than 1 x 5 days. Sick days on Fridays and Mondays counted more heavily than sick days on other days.

 

[AM]

Simplest way to reduce unnecessary GP visits, would be to remove the requirement for employees to provide medical certificates every time they have a couple of days off for a cold.

Actually quite like the idea of Nurse Practitioners as a means of lowering the load on GPs. Issuing medical certificates would be one of many tasks they could perform working collaboratively with the practice GPs.

 

[medusala]

A kiwi mentioned to me the other day that they can choose to see a nurse instead of a doctor at a gp surgery in NZ. Can you do that in Australia? Your idea seems rather sensible to me.

 

[Power Raid]

Actually quite like the idea of Nurse Practitioners as a means of lowering the load on GPs. Issuing medical certificates would be one of many tasks they could perform working collaboratively with the practice GPs.

yep

for vaccinations, blood tests, a "cold", a repeat prescriptions etc could be handled much more efficiently by nurse practitioners

 

[yibbida]

A kiwi mentioned to me the other day that they can choose to see a nurse instead of a doctor at a gp surgery in NZ. Can you do that in Australia? Your idea seems rather sensible to me.

Yeah, I think there is one or two in the entire Perth Metro area.

http://www.npclinics.com.au

 

[samFFC]

yep

for vaccinations, blood tests, a "cold", a repeat prescriptions etc could be handled much more efficiently by nurse practitioners

Vaccines: yes, NP could do.

Blood tests: Doctor gives a referral, patient usually would visit a pathology clinic eg. Pathwest, Clinipath. So no need for NP for that. Could order some tests, yes. But if they need a lot, should they be seeing a GP instead?

"Cold": somewhat risky, given that the symptoms of a cold/flu can be the result of a huge array of diseases. Mostly harmless, but occasionally could be a bad bacterial infection (eg. Pertussis), or the early stages of a severe viral illness.

Repeat prescriptions: if in the context of a chronic disease management plan, then yes. Always good to make sure a script is still needed before just repeating and dispensing. But in many cases, this would be a useful idea.

In a similar vein, things like basic medical examination for chronic disease patients could be a very useful tool in medical management.
eg. Diabetes patient comes for monthly/quarterly check-up, Nurse does the Blood Pressure, Heart Rate, Respiratory Rate, Blood Glucose prick test. And this info can either be recorded and charted for trend assessment, or passed on to the GP for the appointment.

Could also do quick ECGs, and other brief, frequent tests.

 

[MaddAdam]

Is the thin end of the wedge. Will be $20 before you know it.

If Abbott cares so much about the "ballooning" health budget, there's plenty of middle class welfare he could cut.

 

[Slax]

I actaully think the proposal is half decent. I don't approve of the fee to visit a GP, but do for emergency room visits. I've unfortuantely had too much experience of being in emergency rooms and have constantly seen emergency rooms full of people who don't need to be there.

For the record I'm epileptic and suffer grand mal siezure, now called Tonic Clonic, which generally happen early in the morning and either lead to serious injuries (I could detail them but it would waste half a page) or happen in public where someone calls an ambulance.

I believe that charging people who attend emergency rooms and are not admitted should happen and it should be just $5, make it $20 so that emergency rooms can actually treat those who need to be there.

This will force people back to GPs and if you allow for nurse practitioners it will help clear many who visit a doctor for minor reasons. I have to go 3 times a year to get scripts and blood tests, do I need to see a doctor for this? hell no, but I have to anyway. No doubt there are many others like me, add in those getting immunisation/flu shots and you find that the appointments with an actual GP that are freed up more than cover for those who would now go to the GP instead of an emergency room.

 

[Stumpy Pete]

Is the thin end of the wedge. Will be $20 before you know it.

If Abbott cares so much about the "ballooning" health budget, there's plenty of middle class welfare he could cut.

But what happens when the growth in health spending swallows the savings from the cuts to middle class welfare? Funidng for health care is swamping state and territory budgets and continues to represent a growing proportion of Commonwealth spending.

At some point the health care budget will need to be trimmed and not be continually funded from cuts to other sectors or increases revenues. The earlier reforms are made the less drastic and severe their initial impact will be. For example had the mandatory medicare co-payment introduced in 1991 by the Hawke Government (at an initial price of around $2.00) continued would we really be protesting so much about a $6.00 co-payment today?

Some people argue that by fighting against the introduction of a co-payment we are protecting Medicare for future generations - I'd suggest that refusing to reform Medicare simply exacerbates the pain that futures generations will feel when Medicare reforms becomes inevitable.

Regards

S. Pete

 

[Maggie5]

I actaully think the proposal is half decent. I don't approve of the fee to visit a GP, but do for emergency room visits. I've unfortuantely had too much experience of being in emergency rooms and have constantly seen emergency rooms full of people who don't need to be there.

For the record I'm epileptic and suffer grand mal siezure, now called Tonic Clonic, which generally happen early in the morning and either lead to serious injuries (I could detail them but it would waste half a page) or happen in public where someone calls an ambulance.

I believe that charging people who attend emergency rooms and are not admitted should happen and it should be just $5, make it $20 so that emergency rooms can actually treat those who need to be there.

This will force people back to GPs and if you allow for nurse practitioners it will help clear many who visit a doctor for minor reasons. I have to go 3 times a year to get scripts and blood tests, do I need to see a doctor for this? hell no, but I have to anyway. No doubt there are many others like me, add in those getting immunisation/flu shots and you find that the appointments with an actual GP that are freed up more than cover for those who would now go to the GP instead of an emergency room.

Actually, I don't mind the idea of paying $5.00 when visiting emergency at least that goes back into the health system. I also agree that that seeing a nurse practitioner is a good idea as I have a heart condition where I have to go to the doctors every three months for blood tests and prescriptions and a nurse could easily do this.

What I do object to is the co-payment which neatly goes back into the budget and not to health care and they would be looking at it purely as a saving against the budget.

 

[Power Raid]

Vaccines: yes, NP could do.

Blood tests: Doctor gives a referral, patient usually would visit a pathology clinic eg. Pathwest, Clinipath. So no need for NP for that. Could order some tests, yes. But if they need a lot, should they be seeing a GP instead?

"Cold": somewhat risky, given that the symptoms of a cold/flu can be the result of a huge array of diseases. Mostly harmless, but occasionally could be a bad bacterial infection (eg. Pertussis), or the early stages of a severe viral illness.

Repeat prescriptions: if in the context of a chronic disease management plan, then yes. Always good to make sure a script is still needed before just repeating and dispensing. But in many cases, this would be a useful idea.

In a similar vein, things like basic medical examination for chronic disease patients could be a very useful tool in medical management.
eg. Diabetes patient comes for monthly/quarterly check-up, Nurse does the Blood Pressure, Heart Rate, Respiratory Rate, Blood Glucose prick test. And this info can either be recorded and charted for trend assessment, or passed on to the GP for the appointment.

Could also do quick ECGs, and other brief, frequent tests.

Yep, there are many areas a NP could assist and your right there will always be exceptions and that is why the NP needs to be trained and the confidence to say "hold on, I will just get the GP opinion and thoughts on...."

 

[Power Raid]

Actually, I don't mind the idea of paying $5.00 when visiting emergency at least that goes back into the health system. I also agree that that seeing a nurse practitioner is a good idea as I have a heart condition where I have to go to the doctors every three months for blood tests and prescriptions and a nurse could easily do this.

What I do object to is the co-payment which neatly goes back into the budget and not to health care and they would be looking at it purely as a saving against the budget.

My dad has been required to do this monthly for 45 years. No blood test, just a "how is it going" from the doctor and then the prescription.

I think he takes something called warfarin.

I think I prefer your service, even if it means a jab.

 

[CLUBMEDhurst]

yep

for vaccinations, blood tests, a "cold", a repeat prescriptions etc could be handled much more efficiently by nurse practitioners

There was a great scheme, federally funded, for the provision of mental health nurses within GP's practice. Unfortunately was scrapped by the previous government

 

[Power Raid]

There was a great scheme, federally funded, for the provision of mental health nurses within GP's practice. Unfortunately was scrapped by the previous government

state or federal govt?

I think there is plenty of flexibility to provide lower cost but still quality healthcare. Sure there will be roll out issues and sure there could be the requirement of more training for nurses or GP assistants etc.

but at the end of the day, health care needs to be affordable for even the poorest parts of our society (even if they are subsidised by the govt).



You also mentioned mental health. This and dental are probably the two biggest issues in a health system other than costs and waiting times.

 

[CLUBMEDhurst]

state or federal govt?

I think there is plenty of flexibility to provide lower cost but still quality healthcare. Sure there will be roll out issues and sure there could be the requirement of more training for nurses or GP assistants etc.

but at the end of the day, health care needs to be affordable for even the poorest parts of our society (even if they are subsidised by the govt).



You also mentioned mental health. This and dental are probably the two biggest issues in a health system other than costs and waiting times.

I shouldn't have said "scrapped", meant "frozen"

In May 2012 the Gillard Government announced an additional $17.6 million for the Mental Health Nurse Incentive Program. This additional funding was not enough to keep up with the growth of the Program. In effect, the MHNIP was frozen at 2011-2012 levels.
The ACMHN implemented a campaign calling on the Gillard Government to life the freeze and allow the MHNIP to meet the ever increasing demand for mental health services. While the campaign did not lead to the Government changing its decision, there was widespread support from consumers, carers, GPs, psychiatrists, Medicare Locals, and the wider mental health sector.

http://www.acmhn.org/news-events/policy-and-advocacy/mhnip-freeze-campaign

 

[clogged]

But what happens when the growth in health spending swallows the savings from the cuts to middle class welfare? Funidng for health care is swamping state and territory budgets and continues to represent a growing proportion of Commonwealth spending.

At some point the health care budget will need to be trimmed and not be continually funded from cuts to other sectors or increases revenues. The earlier reforms are made the less drastic and severe their initial impact will be. For example had the mandatory medicare co-payment introduced in 1991 by the Hawke Government (at an initial price of around $2.00) continued would we really be protesting so much about a $6.00 co-payment today?

Some people argue that by fighting against the introduction of a co-payment we are protecting Medicare for future generations - I'd suggest that refusing to reform Medicare simply exacerbates the pain that futures generations will feel when Medicare reforms becomes inevitable.

Regards

S. Pete

What proportion is being swallowed by GP visits, or more to the point, unnecessary GP visits?

 

[AM]

Vaccines: yes, NP could do.

Blood tests: Doctor gives a referral, patient usually would visit a pathology clinic eg. Pathwest, Clinipath. So no need for NP for that. Could order some tests, yes. But if they need a lot, should they be seeing a GP instead?

"Cold": somewhat risky, given that the symptoms of a cold/flu can be the result of a huge array of diseases. Mostly harmless, but occasionally could be a bad bacterial infection (eg. Pertussis), or the early stages of a severe viral illness.

Repeat prescriptions: if in the context of a chronic disease management plan, then yes. Always good to make sure a script is still needed before just repeating and dispensing. But in many cases, this would be a useful idea.

In a similar vein, things like basic medical examination for chronic disease patients could be a very useful tool in medical management.
eg. Diabetes patient comes for monthly/quarterly check-up, Nurse does the Blood Pressure, Heart Rate, Respiratory Rate, Blood Glucose prick test. And this info can either be recorded and charted for trend assessment, or passed on to the GP for the appointment.

Could also do quick ECGs, and other brief, frequent tests.

Agree with most of your post but wouldn't add all the caveats.

The key for a Nurse Practitioner is to work collaboratively with the GP's. History taking, medical certificates, injections, blood pressure and other obs, arranging hospital admissions and liaising, attending to things like abrasions, repeat prescriptions, advising pathology results et al.

On the last point, the practice I use to attend had an NP (interestingly started at 2 days a week and ended up working 4) and one of her roles was to contact patients with pathology results. The practice I currently go to has no NP and to find out blood test results you have to initiate contact. As non trained staff can't give them that means contact with the GP. I'm sure that applies to results that come back within the normal range and if there was anything insidious contact would be made. However, it's far from ideal and not uncommon so I'm told.

 

[Andre]

I like the proposal as a means to discourage pointless visits (it'd need to apply to Emergency rooms as well), but doesn't address the health budget could be halved, if not reduced even more if politicians had the balls to properly tackle the big three self-inflicted harms people do to themselves.
Obesity, alcohol and cigarettes. Cigarettes are caught to some extent on the buy side, but all three could be hit either on the cost side or on an ongoing year to year basis.

Obesity is the big one (no pun intended). Heart attacks, some cancers, etc. a contributing factor for. If you consider it fully the cost for it goes beyond the strict medical budget. How many of the massive number of back injuries leading to being on the Disability support pension have excessive weight as a contributing factor? Type II diabetes would almost disappear off the radar if no one was overweight. Add in the need to switch people from living at home or low support to higher support units after falls, where if they'd been carrying less weight they'd have made a fuller recovery. It's the insidious self-inflicted condition that has costs going throughout the government.

Alcohol is somewhat easier to attack. Raise the drinking age to 21 for a start. Then bump up the excise on it as well. It's not a silver bullet, but it would have an effect. Accompany with increased penalties to supplying alcohol to anyone under 21. Then as so many Friday and Saturday night Emergency department visits have alcohol as a contributing cause have everyone going to emergency required to take a breath test. No one would be refused treatment, but if they are over 0.05 have a $100 bill sent to them. Similarly if the breath test shows up drugs they'd cop the fine.

The nurses been able to see patients is a good idea. I'd have it everyone over 18 is required to have a nurse take their fat % (BMI is useless as lots of fit people would be classified 'overweight'), a hair sample and a blood test annually. Those that are overweight would get 1% added to their medicare levy, obese 2%. If not working than as a requirement of getting a pension of any sort they need to undertake addressing the issue. Purchasing alcohol or tobacco would have ID recorded. Those that purchase tobacco in a year, add another 1% to their medicare levy, those on a pension of any sort, would face a reduction. Those who purchase over a certain amount of alcohol in a year would get 1% further on their medicare levy.

Harsh? Sure. Draconian? Yeah, most likely. But it addresses my key issue that those who choose to knowingly undertake lifestyle choices that everyone knows are unhealthy are the ones who have to pay the cost of it, not everyone pay for people's poor decisions. The money saved would leave the health system fully able to cope with those who are forced to interact with it through no choice of their own. A sustainable health system, a fitter population, less violence, people living longer and longer in their own homes without help. I'd say the trade off would be worth it.

 

[samFFC]

Agree with most of your post but wouldn't add all the caveats.

The key for a Nurse Practitioner is to work collaboratively with the GP's. History taking, medical certificates, injections, blood pressure and other obs, arranging hospital admissions and liaising, attending to things like abrasions, repeat prescriptions, advising pathology results et al.

On the last point, the practice I use to attend had an NP (interestingly started at 2 days a week and ended up working 4) and one of her roles was to contact patients with pathology results. The practice I currently go to has no NP and to find out blood test results you have to initiate contact. As non trained staff can't give them that means contact with the GP. I'm sure that applies to results that come back within the normal range and if there was anything insidious contact would be made. However, it's far from ideal and not uncommon so I'm told.

Good points.

And the key is collaborative working, rather than mere replacement. Many people already attend Complementary and Alternative medical practitioners more often than a GP. Perhaps many more would likely attend an NP instead of a GP, especially given a nurse has a medical qualification, just not to the same level of knowledge or experience as a GP.

An NP could certainly perform the majority of things otherwise covered, though I feel the caveats I outlined are still very real risks. eg. If a patient has a "simple cold", the GP could easily see them in and out the door, if there was nothing to worry about, but important for them to see the patient in case they suspected a more sinister cause (esp. for a child, an elderly patient, an immunocompromised patient etc.).

As I said, and you clearly articulated as well, working alongside GPs is the key to the success of the NP within Australia's health system moving forward.

 

[samFFC]

I like the proposal as a means to discourage pointless visits (it'd need to apply to Emergency rooms as well), but doesn't address the health budget could be halved, if not reduced even more if politicians had the balls to properly tackle the big three self-inflicted harms people do to themselves.
Obesity, alcohol and cigarettes. Cigarettes are caught to some extent on the buy side, but all three could be hit either on the cost side or on an ongoing year to year basis.

Obesity is the big one (no pun intended). Heart attacks, some cancers, etc. a contributing factor for. If you consider it fully the cost for it goes beyond the strict medical budget. How many of the massive number of back injuries leading to being on the Disability support pension have excessive weight as a contributing factor? Type II diabetes would almost disappear off the radar if no one was overweight. Add in the need to switch people from living at home or low support to higher support units after falls, where if they'd been carrying less weight they'd have made a fuller recovery. It's the insidious self-inflicted condition that has costs going throughout the government.

Alcohol is somewhat easier to attack. Raise the drinking age to 21 for a start. Then bump up the excise on it as well. It's not a silver bullet, but it would have an effect. Accompany with increased penalties to supplying alcohol to anyone under 21. Then as so many Friday and Saturday night Emergency department visits have alcohol as a contributing cause have everyone going to emergency required to take a breath test. No one would be refused treatment, but if they are over 0.05 have a $100 bill sent to them. Similarly if the breath test shows up drugs they'd cop the fine.

The nurses been able to see patients is a good idea. I'd have it everyone over 18 is required to have a nurse take their fat % (BMI is useless as lots of fit people would be classified 'overweight'), a hair sample and a blood test annually. Those that are overweight would get 1% added to their medicare levy, obese 2%. If not working than as a requirement of getting a pension of any sort they need to undertake addressing the issue. Purchasing alcohol or tobacco would have ID recorded. Those that purchase tobacco in a year, add another 1% to their medicare levy, those on a pension of any sort, would face a reduction. Those who purchase over a certain amount of alcohol in a year would get 1% further on their medicare levy.

Harsh? Sure. Draconian? Yeah, most likely. But it addresses my key issue that those who choose to knowingly undertake lifestyle choices that everyone knows are unhealthy are the ones who have to pay the cost of it, not everyone pay for people's poor decisions. The money saved would leave the health system fully able to cope with those who are forced to interact with it through no choice of their own. A sustainable health system, a fitter population, less violence, people living longer and longer in their own homes without help. I'd say the trade off would be worth it.

Interesting points, and a good argument. Some points:

1. Raising the drinking age to 21 is unlikely to be of much benefit at all, and would instead simply increase the number of people breaking the law, adding workload to our law enforcement. Similar to how legalising marijuana is not necessarily going to lead to a massive increase in usage, harmful usage and health effects.

2. Obviously there is difficulty in measuring how much alcohol a person drinks each year, or if a person purchased tobacco or just pinches one or two off others, but the overall idea of charging a higher levy to those putting themselves more at risk has some merit.
Perhaps the easiest way to do this would be to increase excise, as you have suggested. That way it's a direct cost, avoids asking each person a detailed background of usage, provides an incentive for people not to share with others ("that ciggy cost me $5 mate!!" ) and so on.

3. I think another huge issue is that Obesity and the metabolic syndrome (high blood pressure, type 2 diabetes, high lipids etc.) have spiked in such a short space of time. Rates have gone through the roof, but education has failed to keep up.
As a youngish person I remember Health Education at high school being lacking in detailed education regarding food choices, practical ways to keep fit etc.. We learnt about cigarettes and other drugs, but not enough about food and alcohol, which are probably the big ones now, given the dramatic drop in tobacco usage.

Also, in medical education, students aren't taught enough about how to achieve lifestyle modification amongst patients. Too much focus on obscure diseases, procedures and information, and not enough about how to make a genuine impact on patients, to change their life, and prevent the huge negative health outcomes and public health costs that will arise. This is something that wasn't so much an issue 30-50 years ago, and thus current GPs have a complete lack of knowledge about this. This needs to be rectified amongst the current medical cohort, so that future GPs don't make the same mistakes.

Prevention is far, far cheaper than cure.

 

[AM]

Good points.

And the key is collaborative working, rather than mere replacement. Many people already attend Complementary and Alternative medical practitioners more often than a GP. Perhaps many more would likely attend an NP instead of a GP, especially given a nurse has a medical qualification, just not to the same level of knowledge or experience as a GP.

An NP could certainly perform the majority of things otherwise covered, though I feel the caveats I outlined are still very real risks. eg. If a patient has a "simple cold", the GP could easily see them in and out the door, if there was nothing to worry about, but important for them to see the patient in case they suspected a more sinister cause (esp. for a child, an elderly patient, an immunocompromised patient etc.).

As I said, and you clearly articulated as well, working alongside GPs is the key to the success of the NP within Australia's health system moving forward.

Agree that working collaboratively is the key. The only thing I would add is that I would not link an NP with alternative health people such as those with say just naturopathy qualifications. An NP not only has to have a Bachelor of Nursing degree but advanced training as well.

EDIT: To specifically address the topic, I'm a little inclined toward giving the co-payment a trial. I know my GP says many appointments are taken seeing the "worried well". A component of which are (sadly) lonely folk using it as a chance for some companionship. Perhaps a co-payment would act as a disincentive in that respect.

Essentially, however, it's just a bit I kite flying and the chance of it becoming a reality is remote.

 

[Pessimistic]

You could get the private sector to pull its weight rather than cherry picking

Didnt dutton approve a huge rise in premiums and say labor had been too mean to the health funds ?

 

[Power Raid]

I like the proposal as a means to discourage pointless visits (it'd need to apply to Emergency rooms as well), but doesn't address the health budget could be halved, if not reduced even more if politicians had the balls to properly tackle the big three self-inflicted harms people do to themselves.
Obesity, alcohol and cigarettes. Cigarettes are caught to some extent on the buy side, but all three could be hit either on the cost side or on an ongoing year to year basis.

Obesity is the big one (no pun intended). Heart attacks, some cancers, etc. a contributing factor for. If you consider it fully the cost for it goes beyond the strict medical budget. How many of the massive number of back injuries leading to being on the Disability support pension have excessive weight as a contributing factor? Type II diabetes would almost disappear off the radar if no one was overweight. Add in the need to switch people from living at home or low support to higher support units after falls, where if they'd been carrying less weight they'd have made a fuller recovery. It's the insidious self-inflicted condition that has costs going throughout the government.

Alcohol is somewhat easier to attack. Raise the drinking age to 21 for a start. Then bump up the excise on it as well. It's not a silver bullet, but it would have an effect. Accompany with increased penalties to supplying alcohol to anyone under 21. Then as so many Friday and Saturday night Emergency department visits have alcohol as a contributing cause have everyone going to emergency required to take a breath test. No one would be refused treatment, but if they are over 0.05 have a $100 bill sent to them. Similarly if the breath test shows up drugs they'd cop the fine.

The nurses been able to see patients is a good idea. I'd have it everyone over 18 is required to have a nurse take their fat % (BMI is useless as lots of fit people would be classified 'overweight'), a hair sample and a blood test annually. Those that are overweight would get 1% added to their medicare levy, obese 2%. If not working than as a requirement of getting a pension of any sort they need to undertake addressing the issue. Purchasing alcohol or tobacco would have ID recorded. Those that purchase tobacco in a year, add another 1% to their medicare levy, those on a pension of any sort, would face a reduction. Those who purchase over a certain amount of alcohol in a year would get 1% further on their medicare levy.

Harsh? Sure. Draconian? Yeah, most likely. But it addresses my key issue that those who choose to knowingly undertake lifestyle choices that everyone knows are unhealthy are the ones who have to pay the cost of it, not everyone pay for people's poor decisions. The money saved would leave the health system fully able to cope with those who are forced to interact with it through no choice of their own. A sustainable health system, a fitter population, less violence, people living longer and longer in their own homes without help. I'd say the trade off would be worth it.

I am a big fan of swiping the medicare card when buying certain goods like alcohol, tobacco and fast food. Each purchase then effects our medicare contribution payable quarterly.

It would certainly get people thinking about their dietary habits each time they make a purchase.

It would also eliminate the concern of under-age drinking, if the minimum age was 21, as their is a record of who purchased the goods and when. Meaning, policing the law would be much easier especially if the bar code had individual referencing.

Fast food is much harder to control as what determines what is fast food. For me it is relatively simple.......is the food advertised? If yes, it is fast food. By attacking the advertising, you limit the power the fast food outlet has on people and their ability to influence behaviour. If we can change behaviour, then the policy has served its purpose.