David Fong | 方拔萃

openSuSE Aeon on VMWare Workstation 18 Pro

David Fong — Wed, 17 Sep 2025 00:00:00 GMT

Using openSuSE Aeon on VMWare Workstation

openSuSE Aeon is a low-maintenance, minimal desktop system based on an ‘immutable’ version (MicroOS) of openSuSE. Aeon and MicroOS are ‘atomic rolling releases’ which emphasise stability.

That sounds great, but Aeon is also experimental and under development. Sometimes what makes an operating system ‘easy-to-use’ and ‘low-maintenance’ is not entirely consistent with being flexible to use in different environments. In the case of openSuSE Aeon, that includes being installed in a VMWare Workstation! Using openSuSE Aeon on VMWare Workstation is not for the faint-hearted.

Installing openSuSE Aeon on VMWare Workstation

Instead of providing an ISO image, currently openSuSE Aeon provides a .raw.xz file disk image!

Firstly, the .xz file needs to be expanded to a .raw file. In Linux (I used an openSuSE Leap 15.6 host), that can be done with xz or unxz. The resulting .raw disk image cannot be used as an ISO, it needs to be converted to a virtual disk image.

VMWare Workstation prefers .vmdk disk images. .vmdk images can be created from .raw images by using either qemu-img from qemu or VBoxManage from Oracle Virtualbox. I used VBoxManage.

VBoxManage convertfromraw ./Aeon-Installer.x86_64.raw Aeon2.vmdk --format=vmdk

Creating the virtual machine in VMware workstation

The openSuSE Aeon installation disk image uses EFI. Under ‘Options-Advanced’, the VMware Workstation settings for the Aeon machine needs to be set to ‘UEFI’ firmware type (rather than ‘BIOS’). Aeon also strongly prefers “Trusted Platform Module (TPM)”, so the ‘Secure Boot’ setting (under ‘UEFI’) should also be enabled.

Trusted Platform Module (TPM) is preferred for Aeon, this can be added to the VMware Workstation settings for the Aeon machine under ‘Hardware’. TPM might not be available by default for machines set to ‘Linux’ under ‘Options-General’, but is available for machines set to ‘Windows 11’! It is possible to set the machine to ‘Windows 11’ temporarily and then change back to ‘Linux’.

I set the ‘Hardware - Network Adapter’ to ‘Bridged - Replicate physical network connection state’.

openSuSE Aeon prefers disk encryption to be set. I needed to set ‘fully encrypted’ under ‘Options-Access Control’, partial encryption resulted in Aeon asking for the disk password each time I booted the machine.

VMware encryption (and decryption) of the settings file `.vmx`

Unfortunately, if the VMware machine is ‘fully encrypted’, the settings .vmx file is encrypted as well! Which make changes to the virtual machine much more difficult, or just viewing a plain text version of the settings.

Fortunately, there is a Python tool on Github, VMwareVMX which allows decryption (or encryption) of .vmx files using the same password that was used to encrypt the files under VMware’s ‘Options-Access Control’.

pycryptodome packages, which are required by VMwareVMX can be installed through openSuSE YaST.

Critical settings include:

firmware = "efi"
uefi.secureBoot.enabled = "TRUE"
vtpm.present = "TRUE"

The MAC ID can be found under ethernet0.generatedAddress

open-vm-tools

openSuSE Aeon does not by default include open-vm-tools, which improves interaction between the Aeon guest and (in my case) the openSuSE Leap host. I installed open-vm-tools and open-vm-tools-desktop on the base Aeon system using transactional-update.

Remote Desktop (RDP)

I mostly access the Aeon virtual machine through Microsoft Remote Desktop or [Remmina], both of which use Remote Desktop Protocol (RDP). RDP can be easily enabled through GNOME settings, under ‘Settings - Remote Desktop - Remote Login’.

Insecure connection with Microsoft Remote Desktop

When accessing using Microsoft Remote Desktop, GNOME complains of “Continue with an insecure connection? The Remote Desktop connection is not secure. To secure this connection save the connection settings to an RDP file and set ‘use redirection server name:i:1’ on it”. The solution can be found in GNOME forums - ‘Notification for unsecure connections incomprehensible and ugly’.

In summary:

From Microsoft Remote Desktop, save the connection settings to an RDP file
Edit the connections settings RDP file. Edit a use redirection server name... line to use redirection server name:i:1
Open the edited RDP connection settings file in Microsoft Remote Desktop.

Audio

GNOME in openSuSE Aeon uses pipewire for audio. At first, I had not sound/audio coming through to the Microsoft Remote Desktop, and no selectable audio output device in GNOME settings under ‘Sound’.

I tried at least two things, one (or both?) of which might have helped the sound to start working.

Adding my default user to the audio group
Adding the pipewire-module-xrdp RPM package via transactional-update.

Adding the default user (let’s say, johnsmith) can be done with the command:

sudo usermod -a G audio johnsmith

Sometimes playing the sound can be quite choppy. The change in pulsewire settings in Simple Guide: Fix Audio Crackling or Sudden Distortion in Games (Linux + Proton) seem to help, at least partly:

pw-metadata -n settings 0 clock.force-rate 48000
pw-metadata -n settings 0 clock.force-quantum 500

The reddit post includes recommendations to make the pulsewire changes permanent:

mkdir -p ~/.config/pipewire/pipewire.conf.d/
cp /usr/share/pipewire/pipewire.conf ~/.config/pipewire/

Auto-start services in a distrobox

The preferred way to install software in openSuSE Aeon are through flatpaks and distroboxes.

If planning to use a systemctl-style service, note that not all distroboxes have systemd available, and I couldn’t figure out how add systemd after distrobox creation! Best to specify the required systemd options at the time of distrobox creation.

A distrobox can be autostarted, after a user has started the GNOME desktop, by copying the .desktop file into ~/.config/autostart. If the distrobox is named ubuntu2404 then:

cp .local/share/applications/ubuntu2404.desktop ~/.config/autostart/

Note that the ubuntu2404 distrobox is one of those distroboxes that don’t have systemd available with the default installation settings!

Use of mental health treatment plans and disadvantage

Dr David Fong — Thu, 29 May 2025 00:00:00 GMT

Why does a community health service in Victoria bill relatively few mental health treatment plans (MHTPs), although the practice consults and treats a disproportionately high number of patients with mental health conditions (both high- and low-prevalence, such as schizophrenia and bipolar affective disorder)? Are there barriers to access to mental health care due to socio-economic situation? Is mental health need at times unrelated to provision of mental health care in primary care?

This analysis explores questions of inequity and complexity within a general practice population. It explores the question of what drives the writing and billing MHTPs and whether Medicare (health insurance) billing for mental health care can be distorted reflection of mental health care needs and provision.

1 Abstract

Cohealth, a community health organisation serving inner-urban Melbourne, provides primary care to a population with a markedly higher prevalence of both high- and low- prevalence mental health conditions. Despite the high burden of mental illness, only 15.5% of eligible cohealth patients had an up-to-date general practitioner Mental Health Treatment Plan (MHTP), compared to 21.3% nationally. This contradiction — high clinical need but low service uptake — prompted an investigation into potential barriers to MHTP provision in this setting.

Using clinical and billing data, this study explores factors affecting the delivery of MHTPs, including socioeconomic disadvantage (proxied by concession card status), illness severity (low- vs high-prevalence mental health disorders). Logistic regression analysis reveals that patients with a mental health condition and a concession card are less likely to be billed an MHTP than patients with a mental health condition and without a concession card. Patients with low-prevalence (and typically more severe or lifelong) mental health conditions were no more likely to be billed an MHTP than patients with a high-prevalence mental health conditions.

By contrast, patients with a mental health condition and concession card were more likely to be billed a chronic disease management plan and tended to have higher rates of mental health consultations than a patient with a mental health condition and without a concession card. Patients with a low-prevalence condition were more likely to be billed a mental health consultation and tended to have rates of chronic disease management plan billing than patients with a high-prevalence condition.

General practitioners may perceive limited utility in preparing MHTPs for patients unable to afford private psychological care due to high out-of-pocket costs. Patients with severe and persistent mental illness may instead access mental health care through alternative funding pathways that do not depend on an MHTP as a mechanism for care access.

The findings raise questions about equity, access, and the appropriateness of MHTP billing as a proxy for mental health service provision in community health settings or other settings with high levels of patient complexity.

Show the code

Calculating the combined impact of new GP Chronic Condition Management Plan service items and universal bulk-billing

Tue, 27 May 2025 00:00:00 GMT

Photo by Glenn Carstens-Peters on Unsplash

1 Policy changes - bulk-billing and care plan service items

As part of an election promise, the Australian Government released a proposal to increase the incentives for private general practices (sometimes known as ‘family medicine’ or ‘primary care’ practices) to bulk-bill patients. ‘Bulk-billing’ essentially allows a patient consultation with medical clinician to be ‘free’ (no out-of-pocket expense), if-and-only-if the clinician agrees to charge the patient no more than the government-set insurance price for the consultation.

After the election, the details of a long-announced proposal to change the service item and payment structure of GP chronic condition management plans (GPCCMP or ‘care plans’) was announced. As expected, the new structure simplified the items and emphasised financially the value of reviewing the plan (rather than putting emphasis on developing/creating the plan). Somewhat unexpectedly, and disappointingly, the new payment structure would reduce the payment for general practices which do not change the rate of care plan development and review.

An earlier post ‘Calculating the practice benefit of universal bulk-billing - an updated model’ describes the calculation of the impact on practice revenue of adopting universal bulk-billing under a wide range of conditions, depending on existing private gap-fees, the proportion of patients who are currently bulk-billed with current bulk-billing incentives and the current distribution of services (and service fee rebates). A dashboard version of the calculation can be found at https://shiny.davidfong.org/universalbulkbilling/.

This post describes the combined effects of (potentially) adopting universal bulk-billing and the effect of changes to the GP chronic condition management plan (GPCCMP or ‘care plans’) service items on a specific practice in inner Melbourne. It uses a dashboard calculator described in the previous post.

2 The current situation, old care plan service items

The practice services a high-need low socio-economic status community in inner Melbourne. 80% of services are delivered to patients who are concession card holders, pensioners or age 16 and below. Those 80% of services are all bulk-billed, and attract current bulk-billing incentive payments. The remainder of services are potentially ‘privately-billed’ with a flat gap-fee of $35 over and above the service rebate.

However, some services are never privately-billed with a gap fee, e.g. the current care plans and health assessments, even for those patients without a concession card etc.. About three quarters of the ‘regular’ services (i.e. ‘ABCDE’ standard consult items) which under practice-policy could be privately-billed with a gap-fee are not charged the gap-fee either. So the effective mean gap-fee charged for those ‘ABCDE’ standard consult items is much lower, approximately $10.

The current full fee distribution for the most common service items is pictured in Figure 1. The details of the MBS item number distribution can also be found in the ‘medicarebenefits_practice2’ (.csv or .xlsx) spreadsheet file on ‘universalbulkbilling’ github repository. In the same github repository can be found ‘medicarebenefits.csv’ which shows the Australia MBS 2024 fee distribution for the same service items, which could be regarded as the ‘average’ for Australian general practices.

Figure 1: Current MBS fee distribution

The practice has relatively long consults, much longer than the average in Australian general practice. For example, the ratio of level C:B (20-40 minutes vs 6-19 minutes) consults at the example practice is approximately 1:1, compared to the Australian average of approximately 1:4. The practice also does quite a few of the current care plan development items (item 721), which make up 3.6% of the shown service items (vs 2.8% for the ‘Australian average’). The practice does relatively few care plan reviews (item 732) compared to care plan development (721), at a ratio of 0.6:1 (vs 1.3:1 for the ‘Australian average’).

Figure 1 also shows the mean service fee and expected benefit from adopting universal bulk-billing, as calculated with the dashboard calculator. For the examined service items, the current mean-fee is $92.29 per service, with a relative benefit of 12.4% after adopting universal bulk-billing. The potential relative benefit for this practice after adopting universal bulk-billing is high for this practice because of:

high proportion of services currently being bulk-billed with current bulk-billing incentives
low mean-gap-fees being charged for other services
relatively high mean-rebates for current services, due to long consults and relatively high use of high-rebate service items e.g. care plans

(The mathematical reason for why each of these features results in high relative-benefit of adopting universal bulk billing is described in the ‘Mathematical exploration’ section of ‘Calculating the practice benefit of universal bulk-billing - an updated model’.

Current mean fees

3 ‘Business-as-usual’ with new care plan service items

The new care plan service fee structure will replace the care plan development service item ‘721’ with item ‘965’. Item ‘723’ (which is the ‘team care’ component of care plan development) is merged into 965 i.e. abolished. The care plan review item ‘732’ is replaced with item ‘967’.

An example calculation of the effect, using the dashboard calculator, is shown in Figure 2.

Figure 2: Business as usual

The 416 services (both ‘bulk’ and ‘private’) for item 721 ‘GPMP’ are moved to item ‘965’. Item 723 ‘TCA’ is set to zero services.

The 255 services for item ‘732 CDM RV’ are moved to item ‘967’, but the number of services is halved to 128. The reason is that, in this practice, item ‘732’ was almost always charged twice in the same consultation. Since the ‘standard’ consult for this practice is close to an item C (‘36’), it was not generally worthwhile to charge a single item ‘732’, since item ‘732’ has a lower rebate than item C. It is possible under the old system to charge ‘732’ twice, as it was a review for both the 721 ‘GPMP’ and 723 ‘TCA’ service items. Under the new system, it will not be possible to charge the review twice (since any equivalent for item 723 ‘TCA’ has been abolished), the GPCCMP 967 ‘review’ can only be charge once during a care plan review consult.

The end result, if the rate of new care plans ‘965’ is equal to the current rate of old care plans ‘721’ and the rate of new care plan reviews ‘967’ is half the rate of old care plan review ‘732’ is a mean service fee of $92.29, less than the current mean service fee.

If the practice adopts universal bulk-billing, the mean service fee is $102.57. Which is better than the current mean fee, but still less than if the old care plan service item structure was retained.

Current mean fees

4 ‘More care plan reviews’ with the new care plan service items

One benefit of the new care plan structure is that requirements to claim the new care plan service items is less than the old care plan service item numbers. In particular, the old ‘723’ had onerous requirements to contact multiple service providers. So although the new care plan review ‘967’ has less rebate than claiming two of the old review ‘732’s, it is easier to claim review ’967’ than it was to claim two ’732’s.

Making more use of care plan reviews is also the express intent of the change in care plan item structure.

Figure 3 shows the effect where more care plan reviews ‘967’ are done, equalling the number (416) of care plans ‘965’. In this example, the number of item C ‘36’ services is reduced by the same number that ‘967’ has been increased over the ‘business as usual’ case. This particular practice typically does care plans and care plan reviews as an addition to ‘standard’ consults. This is because patients do not come in specifically to do care plans or care plan reviews only, so a care plan review ‘967’ would replace a standard (if long) consult.

This service fee distribution can be found in the ‘medicarebenefits_practice2_cdccmp.xlsx’ spreadsheet file on ‘universalbulkbilling’ github repository.

Figure 3

At last the service mean-fee of $92.89 now exceeds the ‘current’ mean fee.

If this practice adopts universal bulk-billing, the mean service-fee will be $104.36. The calculation can be done for a range of possible 967:932 ratios, as shown in Figure 4 and Figure 5.

Figure 4

Figure 5

Calculating the practice benefit of universal bulk-billing - an updated model

Mon, 03 Mar 2025 00:00:00 GMT

Dashboard available on Amazon Web Services and ShinyApps.

1 Universal bulk-billing incentive

As part of an election promise, the Australian Government as of February 2025 released a proposal to increase the incentives for private general practices (sometimes known as ‘family medicine’ or ‘primary care’ practices) to bulk-bill patients. ‘Bulk-billing’ essentially allows a patient consultation with medical clinician to be ‘free’ (no out-of-pocket expense), if-and-only-if the clinician agrees to charge the patient no more than the government-set insurance price for the consultation.

The alternative to ‘bulk-billing’ is that the clinician charges the patient a price greater than the government-set insurance price, sometimes called private billing. In this case the patient pays the full price of the consultation and the government health insurance will repay the government-set insurance price to the patient.

The proposal to encourage general practices to ‘bulk-bill’ consisted of two parts:

Broadening the current bulk-billing incentive for individual consultations/services to all patients.
- The government had provided bulk-billing incentives for general practitioners to bulk-bill patients previously deemed to benefit more from bulk-billing. The value of these incentives have been 7.35 to 21.85 dollars per service in urban areas.
- Currently the bulk-billing incentive payment for individual consultations is only available to people, usually with less income or assets, who are pensioners, recipients of a government-issued ‘concession card’ and children under the age of 16. The services which are bulk-billed and also qualify for the current bulk-billing incentive payment will be referred to as ‘concessionally bulk-billed’.
- This bulk-billing incentive is paid with each individual consult
If the general practice agrees to bulk-bill all patients, i.e. universal bulk-billing, the government will pay the practice an additional 12.5% over and above the government-set price for each fee-for-service item. This incentive payment is sometimes called a ‘loading payment’. Half (50%) of this payment is to be paid to the practice, the other half (50%) is to be paid to the individual doctor.
- On 25th March 2025, the service items which needed to be bulk-billed, and attract the ‘loading’ payment were defined in the document Bulk Blling Practice Incentive Program: Eligible Services
- The definition of which service items need to be ‘bulk-billed’, and which service items will attract the 12.5% loading was not initially fully defined in the government-provided fact sheet and RACGP FAQ, although they did suggest that consultation items A/B/C/D, mental health care plan and other GP non-referred attendances will attract the 12.5% loading.
  - For this reason, and simplicity, the initial description of this model is constrained to a small number of service types. Later, the model is expanded to all major service numbers, and can be easily expanded to all service types.
- The 12.5% loading is paid quarterly, together with the current quarterly practice incentive program (PIP) payments.

2 Will the proposed universal bulk-billing incentives be financially worthwhile for general practices?

The government has released case examples of practices which would all financially benefit from the universal bulk-billing incentives proposal. Not all real general practices have considered the incentives proposed to be attractive, however. The benefit to real practices may be more nuanced, depending on current private billing levels and current fees charged over the government-set price.

This model demonstrates the effect of pre-existing gap-fees, the proportion of patients which would normally be privately-billed and the inclusion of different non-referred general practice service items into the estimated benefit-loss of adopting the proposed bulk-bill incentive program.

Two examples are presented, followed by detailed description of the model and model variations.

2.1 Practice 1, limited item number inclusion

The first example practice currently concessionally bulk-bills (bulk-bills with the benefit of bulk-billing incentive payments) 50% of its patients. The benefit-loss calculation is based on just a few item numbers (‘A’, ‘B’, ‘C’, ‘D’ and ‘E’). The graph below demonstrates the effect on net-benefit of adopting the bulk-billing incentives, depending on the private ‘gap-fee’ charged by the practice (to those patients who were not bulk-billed or do not qualify for the current bulk-billing incentive payments) prior to adopting the universal-bulk-billing incentives. The light-blue vertical dotted line represents the net-benefit (-8.23 per service) if the practice charged an average gap-fee of $50.

2.2 Practice 2, low gap-fee, care-plan item numbers included

This example practice charges a low (mean) private gap-fee of $35, which applies to every person who is not bulk-billed or does not have access to current bulk-billing incentive rebates. The benefit-loss calculation is based on both standard numbers (‘A’, ‘B’, ‘C’, ‘D’ and ‘E’) and care-plan item numbers. This practice did not charge a gap-fee at all for care-plan item numbers, even for patients who did not have access to to current bulk-billing incentive rebates. The graph below demonstrates the effect on net-benefit of the adopting the bulk-billing incentives, depending on the pre-existing proportion of patients who were concessionally bulk-billed (with the benefit of current bulk-billing incentives) before adopting the universal-bulk-billing incentives.

The light-blue vertical dotted line represents the net-benefit (6.55 per service) if 80% of the practice population was concessionally bulk-billed.

2.3 Net benefit to practice heatmap table

An estimate of net benefit per service for a range of practices, assuming ‘average’ distribution of ABCDE, care plan, health assessment and mental health care plan items, depending on a range of mean gap fees charge to patients who were concessionally bulk-billed.

The heatmap table above helps demonstrate some of the definitions and assumptions in the presented model.

In the ‘concessional bulk-billed 100%’ row in the table above is demonstrated the effect of the universal-bulk-billing incentive scheme on a practice whose practice population all have health care cards etc., and the practice bulk-bills them all. In this case, no additional patients will qualify for the individual service item bulk-bill incentives, but the practice qualifies for the 12.5% bulk-billing incentive ‘loading’ payment paid quarterly.
All patients who do not qualify the current bulk-bill incentive rebates are ‘privately’ billed, even if the ‘gap fee’ is zero dollars (i.e. no gap fee charged above the government rebate for the service item). In the heatmap table above, this is shown most starkly by the item in the bottom-left corner, where the practice ‘privately’ bills 100% of patients (0% of patients bulk-billed with the benefit of current bulk-billing incentives), with a mean gap fee of zero dollars. In this case, the practice can agree to receive the 12.5% bulk-billing incentive loading payment paid quarterly AND all patients will now potentially qualify for the individual service item bulk-bill incentive.
In practical terms, ‘gap fee’ in the heatmap table shown above is not the necessarily the ‘nominal’ gap fee for service items, but the mean gap fee charged when current individual service bulk-billing incentives do not apply. Which may be lower than the nominal gap fee, if lower gap fees are charged for certain services e.g. review appointments, care plans etc..

Following sections will describe how the models were created.

3 Modelling the benefits to individual practices

This model demonstrates the potential financial benefit (or loss) of taking up the universal bulk-billing proposal.

The proposition to test is:

Where Benefit is the benefit from universal bulk-billing and Loss is the revenue foregone from not charging a fee over and above the government-set price for the services.

Both the ‘Benefit’ and ‘Loss’ side of the equation can be broken down into several individual components.

Private services are the services which would have been privately billed - or did not have access to bulk-billing incentives - before a practice agrees to universal bulk-billing. The Mean Gap fee is the amount the clinician charges the patient over and above the government-set price for each service.

Services which would have been previously privately billed are billed at the lower government-set price for the service, but now attract an individual service bulk-billing incentive, at least partly offsetting the Loss from not charging a Gap fee.

‘Bulk-billed’ services includes only those bulk-billed service (no ‘gap’ payment) where the patient currently qualifies for bulk-billing incentive payments. ‘Private’ services include patients where a ‘gap’ fee is charged, but also includes services where the patient was charged no ‘gap’ fee, but does not currently qualify for bulk-billing incentive payments (but will in the future plan).

If the practice agrees to universal bulk-billing, then all services which were previously ‘bulk-billed’ and previously ‘private-billed’ will benefit from the 12.5% universal bulk-billing incentive loading payment.

For more discussion about the mathematical relationship between benefit-per-service, relative benefit and mean fees, mean gap-fees and proportion of existing services which currently receive individual bulk-billing incentives, see ‘Further Mathematical exploration’

3.1 Services

All the ‘code’ below is fully modifiable, and can be changed to reflect individual practice circumstances! If you wish to ‘run’ the code, it is recommended that you ‘run’ the code blocks sequentially, from top to bottom. After you have ‘run’ a code block, you can modify the code and ‘run’ it again without running the previous code blocks.

If you ‘Run Code’ the code block below, a list of numbers in red will appear below the code block, showing the proportion of patients billed Medicare service items A, B, C, D and E.

A limitation of this model is that explicit details are not known regarding which service items are required to be bulk-billed under the proposal, and which services items will attract the universal bulk-billing incentive.

Released documents show that standard fee-for-service items, particularly items ‘A’, ‘B’, ‘C’ and ‘D’, will attract both bulk-billing incentives (individual service and universal bulk-billing incentive) and are required to be bulk-billed under the universal bulk-billing agreement. These are the most common service items to be charged in Australian general practice, and contribute the vast majority of practice revenue. There are other service item numbers, such as care-plan related service items (‘GPMP/721’, ‘TCA/723’ and ‘GPMP RV/732’), which contribute significantly to the practice income of many practices. Care-plan item numbers will be added to an example model described later.

3.2 Gap fees and bulk-billing incentive

Different practices and different clinicians charge different gap fees. The same clinician or practice may charge different gap fees for different services.

The government bulk-billing incentive for individual services varies by the location of the practice. The incentive typically increasing the less urban and more remote the location of the practice.

3.3 Calculating the benefit

We can now calculate the average benefit per patient if the practice adopts universal bulk-billing.

If you ‘Run Code’ the block below With the default settings of 50% of patients are concessionally bulk-billed and a mean gap fee of 50, the benefit-per-patient is shown as -7.84, i.e. a loss of $7.84 compared to the current mean fee of 87.76.

Note that ‘Run Code’ below will not work unless the previous code blocks have already been ‘Run’!!

3.3.1 Modifying the model for a different practice

What happens if we change some of the parameters? In this example, 80% of services are concessionally bulk-billed, the gap-fee for each privately-billed service item is $35 and the service items charged is biased towards the longer consult items.

If the mean gap fee is set to 35, the average consult length is longer and 80% of patients are concessionally bulk-billed, the practice can expect a mean benefit of 5.66 per service more than the current mean fee of 91.91. Note that this practice has a higher current mean fee than the first practice, but longer consultation times would likely result in a lower fee-rate per hour.

3.3.2 Including care plan item numbers

The ‘Strengthening Medicare with more bulk billing’ information for GP providers and RACGP FAQ state that non-referred general practice service items such as care-plans and health assessments will also qualify for the new bulk-bill incentive payments. We can add these service items to our model. We will base this model on the second practice model.

Compared to the second practice model described above, adding care plan item numbers increases the mean benefit from 5.66 to 6.95 per service. The current mean fee has also risen, from 91.91 to 97.81, reflecting the higher value of service items included.

3.4 Graphing the benefit

3.4.1 Different mean gap fees

We can look at the effect on benefit-loss by looking at a range of different mean gap fees. This graph is based on the first, original, example.

The above code chunk creates a plot like this, with a dashed red line at ‘zero’ benefit and a dotted blue line representing the current mean gap fee:

3.4.2 Different previous gap-billing proportion

Likewise, we can examine the effect on net benefit through a range of different proportion of patients being concessionally bulk-billed prior to adopting universal bulk-billing. This graph is based on the second example.

The above code block will produce a graph as below.

3.4.3 Heatmaps of benefit vs gap-fee and proportion privately-billed

We can draw a heatmap of benefit vs gap-fee and proportion privately-billed.

The data in these plots are based on ABCDE/care plan/health assessment and mental health care plan item proportions as found on Medicare statistics for 2024 i.e. the ‘mythical average’ general practice. As usual, you can modify the proportion yourself in the code below.

The code-block below also has code to generate 3D and interactive plots. Unfortunately, these 3D and interactive plots cannot be created ‘on-the-fly’ from the code-block on your web-browser, but can only be fully modified by copying into R/RStudio.

Below is an example 3D plot which is generated with the above code block. Note that the 3D plot below will not change if you manually change the values in the above code-block. To generate and modify this plot yourself, you will need to copy the code into RStudio/R and run the code yourself.

Code

Calculating the practice benefit of universal bulk-billing

Fri, 28 Feb 2025 00:00:00 GMT

This document has now been updated, please refer to Calculating the practice benefit of universal bulk-billing - an updated model. Updated model includes MBS Service Level A and, optionally, care plans (721/723/732)

Universal bulk-billing incentive

The proposal to encourage general practices to ‘bulk-bill’ consisted of two parts:

Broadening the current bulk-billing incentive for individual consultations/services to all patients.
- Previously the bulk-billing incentive payment for individual consultations was only available to people, usually with less income or assets, who are pensioners, recipients of a government-issued ‘concession card’ and children under the age of 16.
- This bulk-billing incentive is paid with each individual consult
If the general practice agrees to bulk-bill all patients, i.e. universal bulk-billing, the government will pay the practice an additional 12.5% over and above the government-set price for each fee-for-service item.
- The definition of which service items need to be ‘bulk-billed’, and which service items will attract the 15% bonus is not yet fully defined. The government-provided fact sheet suggests that at least consultation items B/C/D and mental health care plans items will attract the 12.5% bonus.
- The 12.% bonus is paid quarterly, together with the current quarterly practice incentive program (PIP) payments.

Will the proposed universal bulk-billing incentives be financially worthwhile for general practices?

Modelling the benefits to individual practices

A model will be demonstrated which aims to show the potential financial benefit (or loss) of taking up the universal bulk-billing proposal.

The proposition to test is:

Where Benefit is the benefit from universal bulk-billing and Loss is the revenue foregone from not charging a fee over and above the government-set price for the services.

Both the ‘Benefit’ and ‘Loss’ side of the equation can be broken down into several individual components.

Private services are the services which would have been privately billed before a practice agrees to universal bulk-billing. The Gap fee is the amount the clinician charges the patient over and above the government-set price for each service.

Services

If you ‘Run Code’ the code block below, a list of numbers in red will appear below the code block, showing the proportion of patients billed Medicare service items B, C, D and E.

A limitation of this model is that full details are not known regarding which service items are required to be bulk-billed under the proposal, and which services items will attract the universal bulk-billing incentive.

Released documents show that some standard fee-for-service items, particularly items ‘B’, ‘C’ and ‘D’, will attract both bulk-billing incentives (individual service and universal bulk-billing incentive) and are likely to be required to be bulk-billed under the universal bulk-billing agreement. These are the most common service items to be charged in Australian general practice, and contribute the vast majority of practice revenue. Item ‘A’, for consultations lasting less than five minutes, is also a common and standard fee-for-service item, but does not currently attract the individual high value ‘triple’ bulk-billing incentive for pensioners and healthcare-card holders etc., and is perhaps unlikely to attract that incentive in the future.

Gap fees and bulk-billing incentive

Different practices and different clinicians charge different gap fees. The same clinician or practice may charge different gap fees for different services.

The government bulk-billing incentive for individual services varies by the location of the practice. The incentive typically increasing the less urban and more remote the location of the practice.

Calculating the benefit

We can now calculate the average benefit per patient if the practice adopts universal bulk-billing.

Note that ‘Run Code’ below will not work unless the previous code blocks have already been ‘Run’!!

With the default settings of 50% of patients privately-billed and a gap fee of 50, the average loss-per-patient is 7.81. However, what happens if we change some of the parameters?

If the gap fee is set to 35, the average consult length is longer and only 20% of patients are privately-billed, the practice can expect an average gain of +6.50 for each patient seen.

Graphing the benefit

Different gap fees

We can look at the effect on profit-loss by looking at a range of different gap fees. This graph is based on the first, original, example.

The above code chunk creates a plot like this, with a dashed red line at ‘zero’ profit and a dotted blue line representing the current gap fee:

Different previous gap-billing proportion

Likewise, we can examine the effect on net benefit through a range of different proportion of patients being privately billed prior to adopting universal bulk-billing. This graph is based on the second example.

The above code block will produce a graph as below.

Reproducing the universal bulk-billing fact sheet table

(Supplement)

We can reproduce part of the table shown in the government-provided fact sheet representing the total payments received (both individual bulk-billing incentive and universal bulk-billing incentive) for each service for those practices which agree to universally bulk-bill. The original table is shown below:

Note that ‘Run Code’ below will not work unless the previous code blocks have already been ‘Run’!!

The above code block output is shown below, matching the table in the fact sheet.

Technical credits

Thanks to the quarto-webr extension, Claudiu-Cristian’s post on using webR in hugo websites and WebR itself for the ability to run modifiable R models on ‘static’ web-pages!

Windows 11 on Chromebook (Linux ‘Crostini’ container)

David Fong — Thu, 23 May 2024 00:00:00 GMT

Photo by Laura Cleffmann on Unsplash

Using Windows 11 on Chromebook

My Chromebook, an Asus CX9 with i5-1135G7 CPU and 16GB of memory, is extremely versatile. It can operate Android apps which are not available for Linux e.g. Pleco (a Chinese dictionary) and the YouVersion Bible App, as well as powerful and useful Linux applications such as RStudio, a data analysis environment, and Zotero, an academic citation tool.

Application compatibility layers such as CodeWeavers Crossover allow some Windows programs such as Wenlin (a Chinese dictionary) to work just fine, and Microsoft Office more-or-less works, with encouragement.

However, sometimes it is nice to have a complete Windows virtual machine available.

Unfortunately Virtualbox doesn’t work, because of a current lack of nested KVM support.

There is a paid option to run a Windows virtual machine, Parallels. However, using Parallels currently requires Chromebook to be set up as an Enterprise chromebook. This can be done on a ‘home-user’ Chromebook, but the process is involved, and the annual subscriptions required are a bit expensive!

However, there is also a free virtual machine (qemu) which can be used to install Windows. The process is described on Beebom.

Optimising performance

Running Windows 10 on my Lenovo Flex 5 (i5 tenth generation) was a bit slow, to say the least. I was keen to improve the performance of Windows 11 on my Asus CX9. The guide from farmerbb in ‘QEMU/KVM virt-manager vm very slow’ was particularly helpful. I didn’t actually use Leducc’s article ‘Improving the performance of a Windows Guest on KVM/QEMU’, but it looks pretty informative, too.

Like farmerbb, I applied all possible Hyper-V enlightenments.

I disabled all timers except for hypervclock. Like farmerbb, and unlike some other guides, I left hpet disabled.

One particular caution I have with farmerbb’s guide is that the CPU pinning settings is specifically for his 6-core CPU, so blind copying of those settings will probably mismatch virtual cores e.g. matching core 1 to core 6. Some other articles mention getting the pinning setting wrong is a likely cause of worse performance. Currently, I have set any cCPU pinning.

I downloaded the Windows virtio drivers as suggested by farmerbb. I placed both my Windows and virtio driver ISO (currently named ‘virtio-win-0.1.240.iso’) into the Crostini ‘normal’ user’s Download directory. Trying to install with those ISOs from a directory outside the Crostini directories did not work, for some reason QEMU managed to lose contact with the files during the install process. Unlike the QEMU XML snippet provided by farmerbb, I did not provide the address, as this appears to be auto-generated, and did not set cache. Note that the disk file is stored in the libvirt directory.

Standard users cannot access the libvirt directory!

I followed Method 1 in the Ostechnix article!). As sudo, I edited the /etc/libvirt/qemu.conf file, adding:

user = "myusername"
group = "libvirt"

Then restarting the libvirtd service, and making sure my regular user is part of the libvirt group.

sudo systemctl restart libvirtd
sudo usermod -a -G libvirt $(whoami)

Resizing Windows 11 guest window, Spice guest tools, Secure boot

I installed Spice guest tools, but it didn’t seem to be working, especially window resizing. The eventual solution was provided by ‘Wind Slightly’ in the post ‘virt-manager guest resize not working’.

It appears that the secure boot option in the boot manager/BIOS does not allow the spice guest tools to work. I entered the QEMU Windows 11 machine BIOS (I think by pressing the Escape key during boot) and disabled secure boot. After that, windows resize worked properly.

Inactive network (as seen in virt-manager)

For some reason, the network became disabled, as could be seen in the virt-manager GUI.

I was able to restart the network with the instructions included in a post written by elattlat

sudo virsh net-autostart default
sudo virsh net-start default

KDE Activities Overview — Simulating GNOME Super-Key (‘Windows’ Key)

David Fong — Mon, 30 Oct 2023 00:00:00 GMT

Photo by Cem Ersozlu on Unsplash

After my AMD RX570 graphics card no longer seemed to be supported in openSuSE Leap 15.5 (or perhaps any other Linux) for use with Da Vinci Resolve video editor, I replaced the RX570 with an NVidia Geforce RTX 3060.

Took a little to install all the proprietary NVidia drivers into openSuSE (I used the official method and repositories as described on the openSuSE web-pages). I did the installation of the NVidia drivers from the console (since I was not able to reach the login screen on the first few boots). Installation of ‘ndivida-driver-G06-kmp-default’ requires compilation of various modules. Eventually, I don’t think the warning messages about Skipping BTF generation for /usr/src/kernel-modules/nvidia-535.113.01-default/nvidia-drm.ko due to unavailability of vmlinux actually mattered. And there were also multiple warning messages about dracut failing to create various kernel modules for versions of the kernel which weren’t actually installed or being used on my system (include some ‘preempty’ kernels, which I removed). The generated modules were stored in /lib/modules/5.14.21-150500.55.31-default/weak-updates/updates (of course, the actual kernel version may vary with different system).

Using Gnome or KDE with Wayland still seems defective and buggy, with long pauses happening periodically. Using KDE with Xorg seems to be more trouble-free than using Gnome. Perhaps not too surprising, openSuSE’s official desktop manager is KDE.

I did miss the window ‘overview’ function from GNOME, however. Gnome accesses ‘overview’ from the Super (also known as Windows) key. The same function is accessed on KDE with something like Super-W (in KDE parlance Meta-W). A similar function called ‘Present Windows’ Ctrl-F10 is also available in KDE, but unlike ‘Overview’ doesn’t allow for searching for applications to launch/start.

It is possible to map the Super (/Meta/Windows) key to ‘Overview’ in KDE, but it is a little complicated, since the KDE’s Meta key is only used as a key modifier. The solution is found in a Reddit post by AiwendilH.

First, find the list of dbus calls for shortcuts:

$qdbus-qt5 org.kde.kglobalaccel /component/kwin shortcutNames

Overview is in that list (the list can also be seen — with great difficulty — using the GUI application qdbusviewer-qt5).

Test the effect from the shell with:

$qdbus-qt5 org.kde.kglobalaccel /component/kwin invokeShortcut "Overview"

Then set the effect (using instructions from the KDE wiki) with:

$ kwriteconfig5 --file ~/.config/kwinrc --group ModifierOnlyShortcuts --key Meta "org.kde.kglobalaccel,/component/kwin,org.kde.kglobalaccel.Component,invokeShortcut,Overview"
$ qdbus-qt5 org.kde.KWin /KWin reconfigure

Kenya Spur Afrika 2023 - Building the House

David Fong — Wed, 18 Jan 2023 00:00:00 GMT

‘For which of you, wanting to build a tower, does not first sit down and calculate the cost to see if he has enough to complete it’
Luke 14:28

This week Spur Afrika Kenya team took part in two days of workshops! Starting with looking towards hopes and concerns and then how best we work with others. We constructed theories of change (logical frameworks) to write project proposals. Finally, we discussed making difficult budgeting choices. In the meantime, the team had some downtime, away from their usual work at the centre!

It was great seeing individual team members sharing how they work. And figuring out how programs work, from theory into implementation. As well as opening up about how they could prepare or cope with difficulties. Thanks to Tim Chong for helping prepare the structure of the workshops.

The workshops conclude the two weeks of work Rosalie and myself have been working ‘on-site’ with Spur Afrika in Kenya. During this time we have seen so much growth, among the Spur Afrika staff (which has thankfully remained quite stable over the years).

Just as pleasing we have experienced the growth of Spur Afrika senior students and graduates who have throughout been keenly involved in conducting health clinics, running picnics for the other students, doing all the odd-jobs and bringing their experience to mentorship workshops. Just in the last week, we were able to invite a Spur graduate in university to assist, throughout the year, in a specialized technical capacity with reporting program performance.

Rosalie and myself are a little tired, but also very excited at what God is doing with Spur Afrika in Kenya. Thanks in particular to Maureen and Sue who have been particularly kind and generous hosts over the past two weeks. We pray for workers Emily, Patoh and Niko for assistance with health or family concerns. And pray thankfully for all the team and children in Spur and Kenya generally as they show and learn more of God’s Kingdom and promises.

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Mentorship and Self-Care

Rosalie Lui — Mon, 16 Jan 2023 00:00:00 GMT

Let’s talk about mental health, self care and mentorship! ❤️😍🥰

We had a great time training our Kenyan mentors. We talked about taking care of your own mental health so you can take care of others. We also discussed some scenarios to help them problem solve and guide them through their mentorship journey. It was great to hear their thoughts and for them to collaborate with each other.

We also had heaps of fun with playing some games and activities that the mentors can play with the kids. Twister, making jellies and decorating biscuits was a very fun activity!!

It was good to give out the presents that we bought from Melbourne, including the nice samples we got from pinchapoo.

It’s been exhausting but rewarding. We only have the worker retreat left … praying we can have a productive time with our Spur workers. Pray for good health, energy and adequate rest.

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Happy Birthday!

Rosalie Lui — Sun, 15 Jan 2023 00:00:00 GMT

Happy 13th birthday Spur!! 🎂 🤪👯‍♂️💃

Spur is really a teenager. 🤪☺️

I can’t believe we have been running Spur for that long. We survived, well we are thriving! It was so so fun to celebrate a birthday with our Spur Kibera community - plus Andrew who has travelled to Kibera for training with us. It was so amazing to see our sponsored children serve others. They cooked all the food for the BBQ and washed all the dishes by hand. They chopped all the chips by hand! (Without chopping boards) It was especially nice to see our first sponsored child, Salim at the party dancing and serving us. Salim is going to university this year! That’s also so good to witness.

It did feel like a big family partying away. The teens really know how to celebrate. It’s good to see how they are giving back to their community.

Most of our high school graduates this year are all heading into college! What great news! We are really proud of them and I am praying we can see them finish university.

Thanks for praying for our Spur community. I am praying for many more birthdays with cake 🎂.

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Kisumu

Rosalie Lui — Fri, 13 Jan 2023 00:00:00 GMT

KISUMU 🐓😍🥰🧒🧒🕯❤️

My heart melts and feels for the people of Holo, Kisumu. To be a girl or woman 👩 living in a village is a strength but such a challenge. It makes me angry? Or mad? To be a girl living in Holo, you are immediately disadvantaged, your life is forever tied to a man. You need a man for protection, for income, for a future. But when men take advantage of this, it is a disaster.

Men have multiple wives and bride inheritance means a man needs to take care of other females in their family when their husband can’t. It’s such a foreign concept to me, but it’s reality. So it’s not surprising that many girls believe their only hope in life is to get a man and have a child.

Kinda girls is a program we started for the overwhelming need to care for pregnant girls who were abandoned by their families. I met with most of them and it was a eye opener. Their life is not easy. Their babies are so cute. The babies were SO well behaved. I can’t believe we had about 30 babies outside and I didn’t really hear them cry! They also came without anything…. not even a nappy sometimes….😂😭

Anyway, they are being equipped with skills. They have been making soap which they gifted us with 2 bottles. The village leaders were also so happy to meet with us. They gave us 2 chickens! Living ones. 😂🤣

I also enjoyed going into the village to meet families. Phenny lives with her siblings and grandma. Her grandma has to work to support them. The girls had to flee from their abusive father. The father wanted to burn their house down at night, but they managed to change locations. However he still burned down that house with another family in it. Unfortunately, they passed away. The police are now looking for him. 😲

Anyway, it was great to spend time with them and give some health care to the family. The grandma is suffering from back and manual handling problems. We could only offer pain medication. Praying she can earn money quickly so she doesn’t need to work so much. They gave us another chicken when we left. What joy! 🐔

Sorry about the long post. We have returned back to Kibera but I still think about Kisumu. There is so so much need in the village. I pray and hope we can grow in Kisumu and be a source of sustainable living for the people of Holo. This is where are resources will be going to.

Here are a few photos. I also enjoyed sitting back and watching Dr David Fong do his thing. I can be a good assistant and watch my partner flourish. He is always so gentle, kind and patient. Everyone is impressed that he really listens.

I shall post more when I can gather my thoughts. Please pray for the mentors training, board meeting and worker retreat. Still have a few things to plan for. Only God can provide for our needs. He is good even in dark places, especially in dark places. 🕯

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Plead the widow’s cause

David Fong — Fri, 13 Jan 2023 00:00:00 GMT

“Wash yourselves; make yourselves clean;
remove the evil of your deeds from before my eyes;
cease to do evil,
learn to do good;
seek justice,
correct oppression;
bring justice to the fatherless,
plead the widow’s cause.”
Isaiah 1:16-17

An initiative of Spur Afrika in Holo (Kisumu, western Kenya) is to support young single mothers who were unable to continue school upon being with child. This week, Rosalie and myself met many of the young mothers who are, or have been involved, in the twelve-week “Kinda Girls” program. Several of the young women spoke about the rekindling of their dream to further their education, or the skills they had learnt to help support themselves, their family and their child.

Some of the young women themselves did not have fathers (or any parents) as the result of their father’s death, or their mother being abandoned. Their household was often of very poor means, and had struggled to send the young woman to school - or even eat - before the added responsibilities of pregnancy and child-rearing. The situation of widows and unmarried mothers in western Kenya is particularly dire, since in many villages women are not formally recognized as being able to own property unless they have a male sponsor (which could be a ˜real” husband, or a husband of convenience, with all the hazards of the latter attached). There are even still some ideas that relate to women as chattel e.g. bride inheritance.

Many of the children whose education is already being supported by Spur Afrika in both Holo (western Kenya) and Kibera (Nairobi, central Kenya) are orphans or children of widows. Including some children whose pictures were shown earlier by Rosalie and myself during this trip to Kenya.

Praying that God shows his mercy, righteousness and blessing through us for all his loved children.

“Give justice to the weak and the fatherless;
maintain the right of the afflicted and the destitute.
Rescue the weak and the needy;
deliver them from the hand of the wicked.”
Psalm 82:3-4

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Lord of the Dance!

David Fong — Wed, 11 Jan 2023 00:00:00 GMT

“Praise [God] for his mighty deeds;
praise him according to the abundance of his greatness.
Praise him with blast of horn;
praise him with harp and lyre.
Praise him with tambourine and dancing;
praise him with strings and flute.
Praise him with sounding cymbals;
praise him with clashing cymbals.”

Psalm 150:2-5

A wonderful feature of Kenyan life is community dancing and being … loud!

Be it at the Spur Afrika picnic day in Kibera/Nairobi (first video), or the welcome to Holo/Kisumu that the Spur Afrika children gave Rosalie and myself yesterday (second video), there seems to be no end to the dancing and singing!

Church services that we’ve attended are like that as well. Lots of dancing and movement (by those on stage. and the congregation). And almost deafening music!

Churches have, over centuries, been at the forefront of loud music and noises, be it the pipe organ (technological marvels of the day) and pealing bells.

Something about public praise, worship and joy the Kenyans haven’t yet forgotten!

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Dance, Play, Football!

Rosalie Lui — Mon, 09 Jan 2023 00:00:00 GMT

Dance, play, football and a lots of fun! ☺️🕺⚽️

On Saturday we got to take all the sponsored children out of the slum and into the nearby park. It was definitely an experience as it was chaotic to get the children there. They took a public bus and it seems like a miracle but all our stuff and all the children got there.

In the most Kenyan way, there was a lot of loud music and dancing. It was great to see the children doing what they love and spending time having fun. The workers got into the dance competition as well.

It was lovely to get to know some of the children better. We got to interview a few of them. It was extremely encouraging to hear the older kids wanting to pay it forward. It really makes me happy to see them support each other by volunteering with Spur.

We got to give our gifts and take photos. The monkeys were everyone…. they were scary… they tried to take our food.

The Kibera team are doing so well. It’s amazing to see God’s work in there. It’s a community that gives back but supports each other as well.

And let us consider how we may spur one another on toward love and good deeds, not giving up meeting together, as some are in the habit of doing, but encouraging one another—and all the more as you see the Day approaching.
Hebrews 10:24-25

Please pray for safe travels as we go to Kisumu tomorrow.

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Troubles

David Fong — Sun, 08 Jan 2023 00:00:00 GMT

On Friday, we had the last of four busy days of free clinics run by Spur Afrika at the K.A.G. school in Kibera, Kenya!

Spur Afrika provided assessment and free basic medications to 583 children and adults during the week, and free basic dental care to 126. This was done not only by Spur Afrika staff, but also with the considerable and valued help of volunteers, volunteer local doctors and nurses and dentists.

Many of the volunteers are young adults who have recently (or even currently) been mentored and supported in their education by Spur Afrika. This very much reflects the wish, hope and prayer that the children living in Kibera and supported by Spur Afrika in turn also support their communities to grow stronger.

Some children I saw during the week quite quickly revealed symptoms and signs of worry and anxiety. Sometimes about success in their studies, sometimes about relationships with their peers. This is the same as children in Australia in some ways, but perhaps is rendered more acute by severe poverty, dislocated and disrupted families and crowded and sub-optimal living conditions.

In the Gospel of Matthew it is written:

“[Seek God, not treasures on earth. As where your treasure is there your heart will be also] therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Sufficient for the day is its own trouble.” (Matthew chapter 6)

Indeed, for many children and families in Kibera, the day has sufficient enough of its own trouble. Pray that Spur Afrika and others are called and enabled to alleviate some of those troubles.

(video by Patrick Marc)

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Clinic

Rosalie Lui — Thu, 05 Jan 2023 00:00:00 GMT

It’s clinic time. 🏥

I feel exhausted but it’s nothing in comparison to children who are unwell and never get any treatment. It is a privilege to access health care. It is a privilege to be able to give health care.

The weather has been cold and wet. It’s strange to feel cold in Kenya. Back home, we complain that the rain affects our activities but in the slum, it’s a totally different story. The houses or huts are not built for the rain. There is mud EVERYWHERE and so it’s hard to get around. However despite the rain, children have still turned up for our clinic.

We have 5 doctors (mostly local Kenyans plus David), 2 dentists and 1 nurse. It’s been a fairly smooth process getting the children through registration, eye check, weight, temperature, etc. We have had a lot of help from our Spur community, including the older high school kids and graduates. I have had the joy in working with Winny who helped me dispense drugs and translate.

We saw 164 children today and 31 for the dentists. Because we have a local team, we managed to finish by 2pm. It was good to have a rest in the afternoon. Please pray that our energy levels will continue to rise and that we will stay well. It’s been great to see all the children but I have realised I need the rest and some quite time. I have forgotten how many children there are in the slums. It’s overwhelming at times.

We have 2 more days of clinics. Praying we can all continue to work together well. Praying that we can continue to give adequate treatment to all who come. It’s been a joy working with the local clinic, it’s great to be able to network and collaborate.

Also, it is nice to give the children something fun to look forward to, colouring is by far the best thing about the clinic. The excitement is real. (That’s the only station that people want to come back to 😆)

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Love, Justice, Equity

David Fong — Tue, 03 Jan 2023 00:00:00 GMT

All too often, the world just isn’t fair.

Today was our first full day in the Kibera informal settlement (slum) of Nairobi, Kenya. The Spur Afrika staff - including Nico, Sylvia, Kijala and Maureen - were doing home visits for some of the children supported by the Spur Afrika program. Rosalie and myself joined the Spur Afrika staff on their visits.

Andrew’s family was the first family we visited. Andrew - aged 10 years - lives with his grandmother and a younger sibling. Sadly, Andrew’s parents have both passed away. Andrew moved to Kibera to be with his grandmother. She had moved to Kibera in order to find work and make a living. Unfortunately, her means of making a living is very meagre indeed. She gathers charcoal scraps, mixes them with mud. The lumps of mud-charcoal fuel sells for 2.5 Australian cents each.

Spur Afrika has been supporting Andrew to continue his education. Later that day, we met Sharon, also supported by Spur Afrika. She finished her final high school exams in just the past two weeks. She eagerly - and anxiously! - awaits her final results, which will arrive at the end of January. Sharon would like to enrol in a university course in September, perhaps in pharmacy, education or law; all with a view to helping people. She isn’t waiting for her results and university enrolment to help people, however. She will volunteer with Spur Afrika, be it cleaning or clinic work, until she is enrolled in university.

Children finishing primary school (Year 8) are currently on vacation until they start high school (Form 1) in about a month’s time. Many of those in high school will be boarding at a high school far away from Kibera. At the Spur Afrika Centre, many of the children supported by Spur Afrika and finishing Year 8 came to the centre today to receive support, advice and pastoral care before they transition to the next stage of their education.

Where there is inequity, those in God’s Full Life and Kingdom can show compassion and love by working towards equity for all God’s children. As the Psalmist sang:

“Great is the Lord in Zion
He is exalted over all the nations.
…
The King is mighty, he loves justice –
you have established equity.” (Psalm 99:2-4, NIV)

(in the photos, Simon is wearing red, together with a younger siblings his grandmother and a lump of the charcoal-dirt mix. Sharon is wearing yellow in another photograph. In another photo, Patoh is talking to the Year 8 graduates at the Spur Centre).

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Happy New Year!

Rosalie Lui — Sun, 01 Jan 2023 00:00:00 GMT

Happy new year from Kenya!! 🥰😍😘

Thank you for praying for us. We arrived safely and with all our luggage.

Please continue to pray for good health and preparing for our clinics and children days.

We also have heaps of donated goods to sort out. 🤪

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Go Time!

Rosalie Lui — Sat, 31 Dec 2022 00:00:00 GMT

It’s go time!! ✈️

We managed to check in over 100kg of donated goodies. There was a wait to get checked in but we managed to get through.

It’s nearly time to board! We have about 24 hours of travelling. Pray for safety and good health.

Kenya here we come! 😁🥰

Spur Afrika trip 2023 posts

Kenya Spur Afrika 2023 - Packing

Rosalie Lui — Fri, 30 Dec 2022 00:00:00 GMT

Thank you Grace for helping us pack over 100kg of luggage and donated goods. 😆😊 Thank you Grace for taking us to the airport tomorrow.

Tomorrow is the day we fly off! We managed to get a upgrade for our 2nd flight so I am looking forward to something special. Thank you David Fong! It’s a good new year surprise. We don’t know when we will celebrate New year, most likely on the plane.

Please continue to pray for good health, safety and smooth travel.

We are still busy with preparing our Spur talks…I have a mentors day training to write and David has the Spur worker one to write.

Thanks for all the support, prayer and thoughts.

Spur Afrika trip 2023 posts

David Fong | 方拔萃

openSuSE Aeon on VMWare Workstation 18 Pro

Using openSuSE Aeon on VMWare Workstation

Installing openSuSE Aeon on VMWare Workstation

Creating the virtual machine in VMware workstation

VMware encryption (and decryption) of the settings file .vmx

open-vm-tools

Remote Desktop (RDP)

Insecure connection with Microsoft Remote Desktop

Audio

Auto-start services in a distrobox

Use of mental health treatment plans and disadvantage

1 Abstract

Calculating the combined impact of new GP Chronic Condition Management Plan service items and universal bulk-billing

1 Policy changes - bulk-billing and care plan service items

2 The current situation, old care plan service items

3 ‘Business-as-usual’ with new care plan service items

4 ‘More care plan reviews’ with the new care plan service items

Calculating the practice benefit of universal bulk-billing - an updated model

1 Universal bulk-billing incentive

2 Will the proposed universal bulk-billing incentives be financially worthwhile for general practices?

2.1 Practice 1, limited item number inclusion

2.2 Practice 2, low gap-fee, care-plan item numbers included

2.3 Net benefit to practice heatmap table

3 Modelling the benefits to individual practices

3.1 Services

3.2 Gap fees and bulk-billing incentive

3.3 Calculating the benefit

3.3.1 Modifying the model for a different practice

3.3.2 Including care plan item numbers

3.4 Graphing the benefit

3.4.1 Different mean gap fees

3.4.2 Different previous gap-billing proportion

3.4.3 Heatmaps of benefit vs gap-fee and proportion privately-billed

Calculating the practice benefit of universal bulk-billing

Universal bulk-billing incentive

Will the proposed universal bulk-billing incentives be financially worthwhile for general practices?

Modelling the benefits to individual practices

Services

Gap fees and bulk-billing incentive

Calculating the benefit

Graphing the benefit

Different gap fees

Different previous gap-billing proportion

Reproducing the universal bulk-billing fact sheet table

Technical credits

Windows 11 on Chromebook (Linux ‘Crostini’ container)

Using Windows 11 on Chromebook

Optimising performance

Resizing Windows 11 guest window, Spice guest tools, Secure boot

Inactive network (as seen in virt-manager)

Sharing files between Windows (in Crostini) and Linux (in Crostini)

KDE Activities Overview — Simulating GNOME Super-Key (‘Windows’ Key)

Kenya Spur Afrika 2023 - Building the House

Kenya Spur Afrika 2023 - Mentorship and Self-Care

Kenya Spur Afrika 2023 - Happy Birthday!

Kenya Spur Afrika 2023 - Kisumu

Kenya Spur Afrika 2023 - Plead the widow’s cause

Kenya Spur Afrika 2023 - Lord of the Dance!

Kenya Spur Afrika 2023 - Dance, Play, Football!

Kenya Spur Afrika 2023 - Troubles

Kenya Spur Afrika 2023 - Clinic

Kenya Spur Afrika 2023 - Love, Justice, Equity

Kenya Spur Afrika 2023 - Happy New Year!

Kenya Spur Afrika 2023 - Go Time!

Kenya Spur Afrika 2023 - Packing

VMware encryption (and decryption) of the settings file `.vmx`