This article assumes that the calls for more prevention will follow existing patterns. This is not necessarily so.

There is a scale of preventative care from primary (whole of population education - think Slip, Slap, Slop) through to secondary (prevention of the complications of already diagnosed chronic diseases - think of reducing the probability of diabetics getting eye disease or having to have amputations). Arguably we do these two extremes reasonably well and we certainly should continue to expand these programs.

The big hole that Prof Dwyer, Jennifer Dogget and others including myself are suggesting be filled is in the area of secondary prevention. This has not been tried systematically anywhere. In this we have proposed that a new form of general practice (I call it Wellness Centres, Jennifer calls it Primary Care Centres, and the Labor Party calls it GP Super Clinics) in which GPs work alongside allied health practitioners - like nutritionists, exercise physiologists, and psychologists - to address the lifestyle issues (like smoking, obesity, alcohol misuse, and stress) that lead to chronic disease. We believe that putting a fence at the top of the cliff is far more effective (both in terms of finance and in quality of life) than building a hospital at the bottom.

Various estimates of the potential for reducing hospitalisation through prevention are between 30 and 80%. Are these not worth pursuing vigorously?

We simply have to take another approach to cope with the ageing population, increasing obesity, decreasing physical activity, and the ageing health workforce. There are also whole of government approaches such as increasing employment, improving transport and housing that must be taken to reduce the burden on our hospitals.

Until we see hospitals as monuments to the failure of our "health system" and align funding systems to reward health professionals to keep patients well we will continue to fail the Australian people.

Two more or less unrelated thoughts:

1. I wonder if extra services as in allied health, practice nurses etc should be aligned to existing GP practices and based on some core targets, eg, your own GP could refer fat people to Medicare funded dietitians. As opposed to setting up separate clinics with yet another health bureaucracy.

2. I think the experience of many working in health is that their leaders have embraced prevention but want it paid for from the existing pot of money which adds to the funding stress.

"The principal reason public hospitals are under severe strain is the number of elderly patients presenting for treatment, many of whom have co-morbidities - an additional chronic condition - and require complex care."

WRONG

The principle reason that has put our public hospitals under pressure is multi-factural.

If one looks at a time series of available public hospital beds it is easy to see that over the last 30 years available public hospital beds have decreased by around 50%.

Secondly since 1992 the number of medical students have been decreased leading to the current doctor crisis.

Thirdly there has been an increase in complexity and acuity of hospital patients.

The rest of Jeremy's article made for interesting reading in that people with unmeet or unidentified health needs are being uncovered. That makes sense. Unfortunately the nett effect is that by identifying and treating these conditions, people's life expectancy then increases.

However if catching a health condition in the early stages avoids an expensive and prolonged hospitalisation then it is a cost saving measure on the longer term.

Posted by John Wellness, Thursday, 13 December 2007

Until we see hospitals as monuments to the failure of our "health system" and align funding systems to reward health professionals to keep patients well we will continue to fail the Australian people.

John Wellness, I'd like to see what you then propose for our hospitals. Sell the land to developers, close them all down?

You seem to be fixated on the idea that hospitals have failed. Yet it is the politicans and political parties that have failed. Our public hospitals have had to deal with some very poor policies.

If we had the same hospital system as the united states, Australian life expectancy would be a lot lower than it is today.

Waiting times for day surgery in the last week went from a three month waiting time to five months in the western suburbs of Sydney. The long waiting lists came into being (and were contrived) by Hawke and Keating back in the mid 1980's. Then they referred to people as "customers" whilst attacking 66 public hospitals, closing down many. Western Suburbs Hospital had been there for 90years. The wrecking operation on the social infrastructure came into being in order to hand over patients to the private health sector. Large profits expectations were bandied about on the stock markets and black humuor joked about making a killing. Everything was done to wreck Medicare as well. Nothing was too much trouble for the Labor liutenants of capitalism to appease the big profiteers. Howard continued the deliberate and criminal rundown of public health and so will Rudd. Labor's priorities are the defence budget incorporating the Howard government’s plans for new military purchases of 24 F/A-18 Super Hornet fighters and the purchase of 100 Lockheed Martin F-35 Joint-Strike Fighters. War is perceived as far more important than healthcare and hospitals.

The authors analysis serves to underline the notion that all health services equal a Model of Supply induced demand.

Proponents of the more beds equal better health scecnario fail to see there presence represents a failure.

Others suggest improved operative techniques and treatment equal faster outcomes and the efficient use of beds and more cost effective systems - that fails to recognise readmission rates , the effects of cost shifting post acute treatment to other sectors of the health industry or indeed back to the consumer themselves - costs remain, poor health outcomes remain.

Australia is good at keeping the cost of health as a percentage of GDP realtively low. But costs have escalated. At the same time we enjoy very good health outcomes - in spite of the "crisis" .

Better health will come from aggressive life style changes but only over a protracted period of time - results will be imperceptable but inevitable. Campaigns need to be nearly as aggreesive as the AIDS campaign of the 80's .

Critical to this is an examination of resource allocation within the public sector - there is enough money in the networks.

I went to a public sector meeting recently. 30 well paid PS employees (not me) travelled, met, lunched and talked - no resoluitons were put, no decisions were made, no planning was undertaken of note, no health was "done".

The table was awash with PDA's and mobile phones and the floor littered with laptops, the car park was groaning under the weight of government cars and no-one paid for lunch - as a hobby I estimate the cost of these shin-digs -- and this was a cheap one costing us about $5,500 for the three hour meeting. That is but one trifling example

Untill there is a genuine form of audit undertaken on the true cost of the overburden of health delivery little will come out of new service modes. Most of the money is chewed up well before it gets to the bedside or better yet, the patient looking for good health advice.

Posted by James H 13 December
I am a former hospital manager and know that most hospitals do a great job. The clinical staff in them are extremely capable and work hard for salaries considerably less than they would earn in a commercial setting with the same skills. There will always be a need for them.

However their management systems are based on the needs of politicians and the health professions rather than on the needs of their patients. The politicians are being guided by health professionals (and especially by power players within them) rather than taxpayers/patients/consumers (that’s us!). Most surveys/citizens juries etc want more expenditure on mental health and Aboriginal health – areas that politicians and bureaucrats have underfunded for many decades.

AND hospital workloads are increasing rapidly through an ageing population, through advances in technology, through the increasing incidence of chronic disease and through population growth. At the same time as we have a rapidly ageing workforce – particularly in medicine and nursing. We cannot continue on the way we have been going. We cannot build hospitals or train doctors fast enough to meet the emerging need in the short term and we will have to forgo other privileges/pleasures to meet growing hospital costs in the long term.

I believe that a serious sustained multidisciplinary preventative health focus will lead to reduced costs and improved quality of life for all Australians.