People using public hospitals and not declaring their private health insurance.
Elective surgery because someone doesn't like the shape of their god given nose.
Using emergency department for non urgent cases

Peter Baume has clearly described Australia's divided illness management approach to our non-Health system.

There is extra funding coming into sickness care by having a private dimension added to a public system. However, the private dollars take away finite professional resources from the possibility of an integrated public system, and use those resources to optimise private incomes without optimising health outcomes.

There is no obvious private fee-paying business model for an efficient health promotion system. One usual private approach is to con people into buying expensive unneeded "vitamins" when things are going well economically. It took the financial collapse of Nauru to force the populace to walk everywhere, and eat fresh local food to reduce their prevalence of diabetes.

I look forward to contributions to this forum that suggest methods for an efficient health promoting system that "private" primary care practitioners can implement along with their illness management

Peter Baume is on the right track. The well off consume a disproportionate amount of the national spend on health. Money spent does not equate to better health outcomes. The US spends more as a per cent of GDP on health than any other country but life expectancy is less than in countries where the spend is much less.

The big problem in Australia is not that we have a private and a public system but that the private system is largely funded by the taxpayer in an uncontrolled fashion. The public sector is restrained by the yearly budget handed down by the feds and the States. The private sector is free to expand as fast as it likes with the Federal government picking up the tab for substantial parts of the costs of doctors bills (including for pathology and XRay), pharmaceuticals and in-patient care by way of the Private Health insurance rebate. The PHI industry claimed that 'coercing' people into membership by way of penalties for joining after 30 would see a reduction in premiums. Despite their claims the PHI industry has enjoyed increases in federal funding by way of the rebate in excess of inflation year in and year out.

If taxpayers' money was directed to where it was needed we would all be better off, thepoor and the wealthy. It's enough to drive someone to drink.

Hume

There are models of primary health care that go beyond traditional illness-based general practice. Examples of these include the GP Super Clinic model (The original Rudd/Roxon paper "Fresh Ideas, Future Economy" is quite good despite the awful implementation), the Centre for Policy Development's Primary Health Care Centre model (download from http://cpd.org.au/2007/06/a-new-approach-to-primary-care-for-australia/)and the Wellness Centre model (downloadable from http://www.aph.gov.au/house/committee/haa/healthfunding/subs/sub081.pdf).

What is obvious but missed by most is that there has to be different (not necessarily more) models of funding.

The reality is that Australia will not be able to afford to continue letting patients develop chronic diseases when they are preventable

John Wellness,

You posted, on 30/11, 11.40pm:

"The reality is that Australia will not be able to afford to continue letting patients develop chronic diseases when they are preventable"

Could you expand on this John, with some examples perhaps, as it is an interesting tack? All I could think of was the likes of the education campaigns about smoking, obesity, carcinoma, diabetes, diet/exercise and such, or regular checkups/testing for say bowel, prostate, and breast cancers, or are you suggesting genetic predisposition screening perhaps?

Also your 'different models of funding' is an interesting thought, and all I could think of was perhaps funding on the basis of outcomes, rather than simply on services provided, but then I can't see how this might work. Can you elucidate please? Thank you.

Peter.

Peter Baume is on the right track. The public system should be properly funded, available to and used by all Australians - this is actually cheaper to all than our current two tier system and would encourage a quality service. The total pool of health professionals is finite - when they work in the private sector they are not providing care in the public sector: it is a fallacy to believe that using the private system will take the pressure off public hospitals. Allowing the health of the poorer members of society to deteriorate and not providing adequate care is bad for the whole of society and financially expensive in the long run: benefits, loss of work hours, and the long term effect on children. A mark of civilisation is how we treat our most vulnerable. Sadly, we are witnessing this deteriorating, and no, it is not fair.