I agree Maria. Information Technology is an important element, but the most important part is people and attitudes.

A recent Norwegian investigation into preventable hospital deaths concluded "a culture of blame for mistakes keeps those in medicine from learning from hospital errors mistakes", and I think this is one of the core problems in our health system too.

The Patel case is a classic example of something that could have been easily detected and prevented if information been more widely circulated and analysed. Likewise the Shipman case (200 to 1000 intentional murders) shows that doctors are literally getting away with murder because they are not subject to the same scruitiny that any other critical non-medical services providers would be.

Just thought I'd throw in some additions :

The price of medicine goes up, not down. While regulation and lack of an open market is partly to blame, we do need regulation in such a critical area. A larger problem is that the greatest competition is for performance rather than price (or even price/performance). And this is _perceived_ performance, not _actual_ performance. Medical providers have an interest in promoting "new" technology when its really not much better than the "old" stuff. Hence, we can be forever "ascending the cliff-face", without ever pausing to take advantage of the view.

Just what is "best" is also susceptible to change. There's also a tendency to treat more people because the capacity provides itself. Keyhole surgery could have meant we did the same number of operations at lower total cost to society, but as noted by sneekepete, it provided the possibility of doing more operations and churning more money through. Were these additional operations in some sense "the result of marketing", or operations that were always worthwhile, but are now practical because of the lower cost of operations ? I don't know.

The root of spiralling health care costs is the entitlement mentality, the belief that "society" owes me perfect health. For example, do you realize that Panadol is still on the PBS, even though it is usually cheaper to buy it at the supermarket? Why? Because there was such an outcry when the government attempted to take it of the list of subsidized drugs.

Rationing is a fact. Every dollar spent on one intervention is a dollar that could be spent on something else. The question is, where is it most cost-effective to spend our money? This is rationing, and don't be afraid of it. If we didn't carefully use our resources the economy would soon go into a spin and health care would be impossible for most people.

It is not "socially divisive and unreasonable to suppose that those with private insurance can make choices - while those dependent on the public system can’t" - it is simply reality. People with more money can afford to buy things (including health care) that others with less money can't. Accept that fact. If you can't accept that, your only logical alternative is to legislate that every person receives exactly the same income, regardless of effort, experience, skill or talent. Only then would you remove what you perceive as "social division" but what is in fact freedom for people to run their own lives.

The cost of putting economics into health care as a parameter is the cost of losing the patients!
What balderdash is spoken in defense of economic rationalism!
Bits of plastic and metal don't cost thousands of dollars to produce. Its the marketing and paying of reps for brand stuff that costs heaps, so why cant't we just get a generic consumables?
Lets face the facts -= until patients become the focus of healthcare again, all decisions based on economics are going to be flawed and in many case wrong for patients, staff and society as a whole.
Why can't we decide to help people just because they need help?
Life is a gift - we can use it well or ill, we can support it or work against it.
The issues are simple - either we seek to support life and enhance it wherever possible or give in to despair and allow people to suffer early death, denial of their life and denial of our ability to make a difference.
Implant companies make a lot of money - it is probably unnecessary expense if you look at how a person comes to be in the queue for joint replacement!
What happened 20,50 yrs ago? Did we care for people any less - Are we treating the whole person or just opting for the technological easy fix knowing it will fail in x number of years and bonus the implant company each time in a growing arc of profitability and what of the health care provider who is placed on this economic treadmill which has only one end? the answer lies in putting patient care back as our focus and exploring treatment which can aleviate suffering as being superior to treatment which seeks only to fix the problem in the short term.

YOu go get 'em matron.

Mykah has a point we ration now - but we ration in the face of poorly coordinated and over priced services.

We need a PBS not to foster learnt dependance on the gvernment but to offset rapacious pricing by pharmaceutical companies - yes I know they spend money on R and D but they also waste vast sums on promotion and advertising.

There is right now plenty of money invested in the health system but the system is managed by nincompoops.

What a waste of a by and large publicly funded education it is for a doctor to inject collagen into chicks lips, or small doses of the plague into their foreheads to make them look younger or hoist up some ones sagging bosom! Nope we dont need to ration just re allocate the resources