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The Forum > Article Comments > Patient-centred health reform > Comments

Patient-centred health reform : Comments

By Katie Lahey, published 8/3/2010

Healthcare: it's not who pays that's important, it's about getting more value and better service.

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Of all the separate contributors to the excessive cost of healthcare, the one that receives little examination is the fees of GP's as they go about their business, grossing up to $1500 plus per day.
There has been a practice for years of accepting the ever-increasing cost of services from the medical industry without question as the medical union, the AMA, promoting the illusion of a caring and responsible union membership with an overriding interest in patient care, one of their regular drum-thumping statements.
Why have so many sold their souls and their practices to the commercial enterprises, in many cases resulting in yet another increase in fees to cover their burgeoning overheads or some such similar reason.
They are now the single most costly segment of medical expenses with which governments through Medicare and Health Funds through refund payments, struggle to be able to meet such costs.
A recent example shows a anaesthetist involved in 14 cataract procedures in one day in one hospital, billing all of the 14 patients almost $1000 each for a simple procedure occupying no more that 15-20 minutes of attention. Is it any wonder the public and the government are being gouged by such actions.
The medical profession, much more a medical industry in 2010, has long since put paid to the old Hippocratic oath, subscribing more to the current day mercenary hypocritical oath.
Look no further for the reason for health costs, currently not patient-centred in any way and never again likely to return to those halcyon days of family 'caring' doctors.
Posted by rexw, Monday, 8 March 2010 12:03:55 PM
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As you mentioned this is the gross income. Out of that comes the premises, the staff, the insurance. Also this generally requires far more than an 8hr day.

A doctor working within a practise in which the above is covered, would take 30-40% of this.
Posted by Shadow Minister, Monday, 8 March 2010 2:44:35 PM
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The economics are dazzlingly straightforward.

Our health is important to us.

When push comes to shove, and to the extent that the expense is discretionary, most of us would be happy to divert a significant percentage of our incomes in its favour.

More than we'd spend on anything else, really. What's the use of a new plasma screen for the rumpus room if you're not around to enjoy it?

This creates a thing that economists call Demand.

On the other side of the equation we have Supply. (sorry to be so trite. But it really is this simple)

Where there is greater demand than supply, prices tend to rise. (If prices are artificially restrained, of course, supply dries up, and waiting time increases.)

The difference in political terms, of course, is that deep down inside us we believe that health is some kind of Right. Any government that doesn't have a system in place that treats us within fifteen seconds of scraping our knee isn't worth a tuppenny cuss. (Meanwhile, anyone who makes a profit from our misfortune/accident/illness is a heartless, money-grubbing cad.)

Nevertheless, there are two solutions only, when it comes to providing affordable healthcare. Regardless whether it is paid for through taxation or by individuals.

They are: reduce demand, or increase supply.

To reduce demand, you need to develop a healthier population. This sounds good until you realize that it creates more old people, and is therefore self-defeating.

To increase supply, you need more people qualified to provide healthcare.


In the meantime, to make a start towards fixing the Health Service, the government could levy a dollar-per-word tax on articles that talk about instant-pudding solutions for fixing the Health Service.

This windfall could be then spent on training doctors and nurses, and on providing early retirement for 60% of the administrators, increasing the supply of valuable healthcare professionals, and reducing overheads.

If we don't increase Supply, Demand will ensure that costs continue to escalate out of sight. But if you had half a dozen anaesthetists to choose from, they wouldn't be able to charge $1,000 a pop.
Posted by Pericles, Monday, 8 March 2010 2:51:18 PM
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Improving consumers' health literacy is a key factor in patient-centred health reform. Studies undertaken by the US Committee on Health Literacy have highlighted the association between health literacy, health-care utilisation and health-care costs. A current definition of health literacy is - "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions (Ratzan & Parker). Being health literate is more than just being able to read, write and speak - it also involves adequate skills in numeracy, attentive listening, information retention and conceptual knowledge in the context of individuals' health journeys, levels of education, grasp of language and their cultural and social situations.

The American studies found consumers' limited health literacy leads to reduced knowledge of disease management and of health promoting behaviours, reduced health status and less likelihood of uptake of preventive services. This in turn leads to increased rates of hospitalisation and the use of emergency departments and greater health-care costs. Health literacy is fundamental to safe, quality consumer-centred health-care and equitable treatment.

Unfortunately, there is a lack of understanding by most health professionals and policymakers about the extent and effect of poor health literacy and the lack of self-confidence and heightened shame experienced by those health consumers with poor health literacy who have great difficulty trying to communicate with the 'health experts', and navigate an increasingly complex health system and health care practices. In 2003/04 the US Surgeon General said, "health literacy can save lives, save money and improve the health and well-being of millions of Americans".

To raise the health literacy of Australians, it is essential that health knowledge and awareness and biological science are core components of the primary, secondary and tertiary education curricula and that all communication mediums between health consumers and practitioners are in plain, simple English without jargon or 'medical' terminology and respond to the diversity of Australians across the life span and cultural and social arenas.
Posted by cjmcd, Monday, 8 March 2010 6:34:30 PM
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There is a term "suicide by (self)neglect". Basically this term applied to people who have chronic conditions and regardless of any amount of education or attempts at raising their 'literacy'.

Fail or refuse to follow their health care plans, this applies to diabetics, who fail to monitor blood sugars, attend dr's or clinic appointments.

Asthmatics who continue to smoke, renal failure patients and cardiac patients who do not take their preventative medicines.

Improving consumer literacy will not be effective for all consumers.
Posted by JamesH, Monday, 8 March 2010 6:53:47 PM
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Not sure exactly who you are blaming. At first you seem to blame the GPs as being the single biggest cost of medicare. Later you give an example of the anaesthetist.
Would you not expect GPs to be the single biggest cost. After all they are the most common type of medical practitioner in Australia. Around 2/3s of medical graduates become GPs and the average Australian visits a GP around 7 times a year. Yet they would rarely visit a specialist. For the elderly this will be different. For such a labour intensive industry surely you expect the labour costs to be the predominant factor.
As for the amount doctors get paid, I can tell you there is a wide distribution.
You qoute $1500 per day gross. That is an underestimate. The average GP I know would gross around $2000. From this the average commission currently is around 65% so that is $1300 ( before tax). now the average GP works about 4 days ( due mainly to the current dominance of female GPs) so that gives around $5200 per week or 250K per year. So it depends what you think of 250K per year. In comparison to many jobs 250K is fanastic. However in relation to many accountants, dentists and lawyers, it is not great when you consider the average doctor has done at least 2-3 times the training of any of these examples. I have friends in each of these categories that probably earn more than I do, yet have done minimal work to get where they are. One accountant friend told me many years ago now that the top people in his company charged $500 per hour ( this was more than ten years ago).
Another way to look at this is to ask how much each of these people would charge you to see them for 15 mins. The GP gets paid $34 (item B bulk billed) up to about $65 for a private billing practice. I firmly believe a 15min appointment with either the accountant, dentist or lawyer would in general be much more.
Posted by ozzie, Monday, 8 March 2010 11:04:29 PM
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