Category: Health

One of my patients has epilepsy. She sees a neurologist for that and he charges $200 out of pocket per visit. He has controlled her epilepsy very well. She is on a disability support pension. She believes she will get better care seeing him privately despite the fact that he also works in the public system. 

Out of pocket (OOP) costs have been in the news particularly since 4 Corners exposed huge costs impacting significant financial hardship on many sick Australians. As a result of a Ministerial Committee report the Health Minister has proposed tackling the issue with a website of specialist charges and an education campaign for patients. The Committee consisted of ten health care provider representatives and one consumer representative. My suggestion to the Minister that more consumer representatives might be appropriate resulted in an intensely angry response. (more…)

Can you imagine an Australia where visiting a dentist was as simple as visiting a GP? The Grattan Institute has released a report: Filling the dental gap: A universal dental scheme for Australia, that does just this. The report begins by highlighting the disparity between a routine health check with a GP and visiting the dentist; those visiting the dentist might expect it to hurt more, but usually in the pocket more than anywhere else.

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“Oral health is fundamental to overall health, wellbeing and quality of life. It is an important part of general health, affecting not only the individual, but also the broader health system and economy.” So says the 2017 Performance Monitoring Baseline Report for Australia’s National Oral Health Plan 2015 – 2024. This acknowledgement that oral health is an essential component of a healthy life is promising, but how do we know if we are moving towards enshrining good oral health for all Australians?

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At the end of February the Federal Government released the report, twelve months in the making, from the Ministerial Advisory Committee on Out-of-Pocket Costs and outlined a national strategy to tackle excessive out-of-pocket costs. It is our opinion that the report’s recommendations and the Government’s response (for a website that provides information about medical specialists’ costs and for an education campaign to improve the understanding of OOP costs for consumers, GPs and medical specialists) do not go far enough, given the substantial and widespread impact of OOP costs. Our recently published paperoffers a road map for tackling the problems associated with OOP costs through short- and long- term initiatives, backed by evidence and informed by on-going consultation and evaluation.

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LESLEY RUSSELL. Can Primary Health Networks (PHNs) Drive Needed Primary Care Reforms?

A strong primary care system is essential to the equity, efficiency and effectiveness of the healthcare system and for improvements in health outcomes. However, the structure and funding of primary care has not kept pace with changes to disease patterns, the economic pressures on the healthcare system, workforce needs and evidence about the impact of social factors on health. In a paper recently published with my colleague Dr Paresh Dawda, we analyse the current operations and funding of Primary Health Networks and explore whether they are fit-for-purpose to drive and foster primary care reforms.

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Politicians, the media and the public focus on iconic hospitals rather than health.  We have too many hospitals and too many hospital beds.  We need to focus health improvement not in hospitals, but in primary care in the community – general practice, community clinics and at home.  The expensive and wasteful hospital frenzy must end.  (more…)

Beyond the image of the vagabond and the impaired bodies and minds of homeless people there are untapped veins of intellect and potential; this is where our focus should be.

“The homeless are our most important dreamers, prophets and poets for they challenge our apathy….” (Sydney from Below, McCarthy F, Matthew Talbot Hostel)

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There are a number of unsatisfactory elements of the so-called “national” scheme for regulating doctors (and all health professionals) but the most problematic from day one in 2010 has been the requirement for mandatory reporting of ill doctors by their treating doctors. As we reported here in 2017, the state and territory health ministers chose to reject unambiguous advice provided by their consultant, Mr Kim Snowball, who conducted an independent review of the national scheme. He advised the ministers in 2015 that “the National Law (to) be amended to reflect the same mandatory notification exemptions for treating practitioners established in the Western Australian law.”  Instead the ministers embarked on a further round of consultation wasting four years to reach their final conclusion that only a very minor change was needed to the mandatory reporting provisions, thereby maintaining a regressive regime. For those interested in the use of language, the minor change (see page 20) is to alter the threshold for mandatory reporting from the existing ‘risk of substantial harm’ to a ‘substantial risk of harm’. In all the public consultations held over mandatory reporting, the medical profession has repeatedly advised health ministers that mandatory reporting is contrary not only to the health and well-being of doctors but also contrary to the best interests of the community because it deters unwell doctors from seeking help.  (more…)

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Will meaningful and significant reform of the Australian health care system occur at last?

Will there be bipartisan political support for the initiatives proposed by Labor? 2019 could be the year that delivers. (more…)

Shadow health minister, Catherine King, in an address to the National Press Club, has detailed the major health initiatives Labor would embrace if elected in May. Her plans indicate that she has heard and accepted many of the priorities for reform proposed by would be health reformists. The status quo is unacceptable. Most encouraging was her recognition that patient-centred reforms, which must include truly integrated care, was impossible if the current jurisdictional division of responsibility for health care continued. The portfolio of reforms she presented are welcomed and would be readily understood by electors if they could hear these plans. Fears were expressed at her presentation that totally unjustified scare tactics about boarder security might so dominate election debates that these important promises might get little attention. Certainly there has so far been very little media reporting on the health initiatives announced with some of the few comments made by journalists suggesting they did not understand the proposals.

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The Rudd/Gillard governments muddled through on health policy. There was very little  to show in the way of useful reform,with one exception. That was plain packaging of cigarettes. 

  The record is not encouraging, and will not be  better in future if the next health minister spends her time smoodging  powerful providers . Necessary health reforms are hard.  Without  determined  Prime ministerial and health minister leadership  nothing much will change. (more…)

Our health care system provides, at least for metropolitan based Australians, world class management of medical emergencies. A stent in a coronary artery in the middle of the night can save a heart in danger and our dedicated stroke units routinely dissolve blood vessel blockages that could have proved fatal or caused major permanent disabilities. While we can be grateful for these interventions the reality is that the management of the majority of health issues that trouble us do not meet this standard of excellence. (more…)

In 2017 I referred a patient for relatively simple orthopaedic surgery on her wrist to enable her to get back to working in a café.  She had been advised that she was a category 3 patient and should be operated on within 365 days. During this period she couldn’t do her usual part-time work which she could juggle around child care commitments. Furthermore, Centrelink required her to apply for jobs she couldn’t do. It took 6 months to even get on the waiting list. She finally had the surgery 15 months after I referred her. 

Another of my patients had a similar problem. Retired, it stopped him playing golf. He was operated on within a month and is happily back on the golf course. He had publicly subsidised private health insurance (PHI).

Both received high quality health care except for the time delay for the first patient.

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Hidden in a pack of draft reports from the Medicare Benefits Schedule (MBS) Review Taskforce that were released by the Morrison Government without fanfare just before Christmas are a series of recommendations that, if effectively funded and implemented, could begin the long and difficult task of reforming Australia’s primary care system. (more…)

Last year Labor announced that if elected it would refer health funding, particularly private health insurance, to the Productivity Commission, it being 50 years since the value of PHI was last examined by government. It appears, however, that Labor is squibbing on its promise to subject PHI to economic scrutiny, abandoning its historical commitment to defend Medicare from being undermined by PHI. (more…)

The professionalism in hospitals may have contributed greatly to better data collection and use of technology, but after a visit to a hospice and an ICU unit recently, I wondered what has happened to care. Our system is failing us.

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In a world divided by conflict and greed, the Global Fund’s fight against AIDS, tuberculosis, and malaria is a matter of enlightened self-interest and a reminder of how much humanity can accomplish when we cooperate to save lives. For public and private donors, that means providing the financing needed to eliminate all three scourges by 2030.

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Well done John Menadue for starting 2019 off with something that must strike at the heart of all Australians- out of pocket medical expenses. Some of the highest in the world and showing no sign of slowing and driven by – let’s be honest – greed on the part of some of our most highly paid doctors. Despite comments over the last few years from some of the Colleges saying that they do not support the significant fees charged by some doctors (and remember it is not a small minority),  little has changed. Comments from the Colleges have stopped and out of pocket expenses continue to increase. Australians are opting out of health insurance, placing strains on both the public and private systems. How long should Australians put up with this behaviour from the medical profession which seems hell bent on destroying the ‘golden goose’ (uncapped fee for service – i.e. charge what you think you can get away with) that has funded their lifestyle.   (more…)

In the blue-collar area where there have been very substantial workforce reform and improvements which have helped transform the Australian economy. It was begun under the Hawke/Keating governments and continued under the Howard governments. 

But the health sector the largest and fastest growing in the economy has not been seriously reformed. I ‘guesstimate’ that there is a potential productivity dividend of at least 40% in health workforce reform over the next decade. That 40% may be on the low side.

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