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The Forum > Article Comments > Road map for Australian health care reform - Part I > Comments

Road map for Australian health care reform - Part I : Comments

By Fred Hansen, published 5/8/2008

Positive competition based on quality will eventually ring the death bell for one-size-fits-all medicine.

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An interesting argument. But I have concerns about some factors that arenít reflected in your stats that might have hidden skewing effects. Therefore are not addressed in the piece.
1. Many of the compared countries (European) have a greater pool of medical professionals to choose from.
2. Our options of overseas trained doctors. Movement of doctors amongst the European countries would be easier for individuals and their families.
3. Greater familiarity with cultures and languages. Here in Aust overseas doctors issues relating to Australians Fertile ground for miscommunication due, cues to sub texts nuances and cultural attitudes hampering the diagnosis process.
4. A limited number of medical uni places. Europe has more uni medical uni places per head per population than Australia.
5. Unappealing working conditions.(incl. regional outback.) Including perceptions of working in public hospitals. Issues like violence, language/cultural and societal low end problems.
6. The Self interest of Doctors Associations (unions) as gate keepers limiting the number of specialists that can be trained and or admitted.
7. Entrenched networks and there in a small market. Often propping up less than optimum practitioners and/or obsolete techniques etc
8. Doctorís perception a right to a prestigious lifestyle irrespective of effort or merit.
9. Lack of money spent on infrastructure (over crowding) and an overly bureaucratised system. Akin to the tax system in complexity.

I agree that statistical analysis is a valid tool but as stated the generalities tend to be misleading. To fix our system a detailed analysis of local individual components need to fully understood. Otherwise any plan is born to be philosophically driven and impractical, inappropriate on the ground.

I have concern also about the mechanics of marrying two diametrically opposed objectives under one system. Particularly when all evidence is that the profit motive as practiced is neither efficient or runs on a level ground. Thus undermining Capitalismís basic and your rationale. In essence we have a corrupted supply and demand system with amoral Corporatism being the gate keepers to what is a moral issue.
Posted by examinator, Tuesday, 5 August 2008 1:01:33 PM
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There are various ways the health system can be improved at no cost to the government or community.

The first relates to malpractice insurance, which is a significant cost for all medical practitioners. The way to fix this in to introduce a legal framework for medicine similar to that if force for many years in the international aviation industry, in the form of the Warsaw Convention. Essentially this change would cap damages claims for medical malpractice unless malicious negligence is proven, in which case the sky would be the limit.

The second is a method of inducing experienced older overseas doctors to take up positions in areas of Australia difficult to staff. This would be done by enacting that while they occupy these positions, the doctor's overseas income, from investments etc., would be exempt from tax. This would not cost the Australian taxpayer a cent, as if the doctor did not come here, his income would also not be taxed. The only loser would be the overseas country the doctor would otherwise live in. A doctor a few years from retirement with a significant investment income could gain a large benefit from spending a few interesting years here in the outback.
Posted by plerdsus, Tuesday, 5 August 2008 5:16:03 PM
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Oh dear,

welcome to production line medicine, driven by economics.

The author doesn't state that in the US, it is estimated that fraud accounts for around 10% of the trillion dollar health budget.

<"In the pages on this web site I have suggested that the entrepreneurs who found and grow health and aged care corporations so successfully share a number of characteristics which I have called extremely closed minded*. I have also used Robertson et al's concept of a successful sociopath to characterise them*.>"
http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/health/sociopathy.html

Yep making comparison with the most expensive dysfunctional health care system in the world makes good sense.
Posted by JamesH, Tuesday, 5 August 2008 10:03:39 PM
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The AMA or Doctors Reform Society said that the increase in population in Victoria means that there should another 80 public hospital beds opened each year, and this could be paid for out of the savings of stopping the rebate for private health insurance.

I am very cynical of private hospitals after my mother's experience at teh Epworth which reinforced my knowledge of their Kaizen or Just-In-time staffing policies where the hospital hired nursing staff at the start of each shift based upon the number of beds occupied. The staff were preoccupied with figuring out whether they would get enough shifts to pay their rent, were unfamiliar with ward procedure, were culturally insensitive to their patients needs, who on earth thinks Channel Nine is culture or edifying?

When we think of American medicine we think of expensive procedures controlled by Blue Cross, and we know that the poorest quintile of 60 year old Britons has far better health than the upper quintile in the US.

Many Cubans enjoy far better health outcomes than contempory Americans.
Posted by billie, Tuesday, 5 August 2008 10:38:21 PM
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Alot of the problems with the public health care system, have been created and exacerbated by political ideology. Part of the problem is applying a business model to health care.

Keating came out with improved efficiencies, cost effectiveness etc.

The intake of medical students in the 1990's was severely curtailed as a cost saving measure, now there are not enough Dr's.

The failure of successive governments in effective planning and expanding public hospitals to take into account the growing population has created the current climate of extended waiting lists etc.

Lets look at the contributing factors that led up to an adverse event.

Workloads!

Australian public hospitals are under an increasing amount of pressure to treat and discharge patients(sorry consumers)as quickly as possible.

Skill mix!

Staffing levels!

Training and Experience!

See the Story of Health care reform
http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/health/health_reform.html

Competition Improves quality?
http://www.uow.edu.au/arts/sts/bmartin/dissent/documents/health/quality_compet.html
Posted by JamesH, Wednesday, 6 August 2008 4:11:38 PM
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Some new research into the US health system.

<The survey, Public Views on U.S. Health Care System Organization: A Call for New Directions, found that, in addition to respondents' overall dissatisfaction with the health care system, people are frustrated with the way they currently get health care. In fact, 47 percent of patients experienced poorly coordinated medical care in the past two years -- meaning that they were not informed about medical test results or had to call repeatedly to get them, important medical information wasn't shared between doctors and nurses, or communication between primary care doctors and specialists was poor>
Posted by JamesH, Monday, 11 August 2008 7:16:26 AM
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