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The Forum > Article Comments > Health care - doing the sums > Comments

Health care - doing the sums : Comments

By Kevin Pittman, published 28/10/2005

Kevin Pittman argues Australians must learn to pay more for their health care.

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THe AMA understands health economics? maybe - furthermore the AMA is far representative; it is some what metro centric in nature and only one but the loudest of the medical unions.

Kem assumes the system itself is immutable; costs will rise as he predicts if we adopt the do nothing model and accept the current modes of health delivery.

The report of the Productivity commission suggested medicare payments for non medical type undertaken non medical staff - the list of alternatives is lengthy - and includes anaesthetics, colonoscopies, prescribing - I could go on; in various jurisdictions around the globe and in remote areas non medical practitioners are doing those tasks and many more. Many of the tasks are routine and mechanistic in nature - elements of the Rural Doctors Asociation is calling for extended roles for Nurse practitioners.

The AMA has declared several no go zones contending to admit other profession into their territory would represent a dumbing down or be too risky.

The stark realty has been for years that a growing raft of procedures formerly the exclusive domain of the doctor have been taken up by other ranks out of necessity and usally with the tacit consent of the medical work force.

Co payments might be part of the solution - there are a good deal of other system flaws that could be addressed before we go down that path - we still have 7 state and territory jurisdictions administering health - we are still wedded to a fee for service scheme that inflates costs exponentially - we still are greedy and blind consumers of new technology - we still practice overly expensive and overyl defensive medicine - we still spend 2/5 of eff all on preventative medicine - we remain captives of rapacious pricing for pharmaceuticals - we still staff operating theatres with trained registered nurses when competant technicians could fulfill many of their roles cheaper - health system heirarchies remain top heavy - consultants to health departments suck up huge amounts of resources

Lets take a serious look at some of those issues.
Posted by sneekeepete, Friday, 28 October 2005 12:29:51 PM
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Pittman does highlight a few of the problems, the ones that 'Blind Freddy' can see, but he gets himself horribly muddled as well. He states "there is no such thing as free health", then praises the idea of "self management of their own health". Kevin, self management can be free. So there is such a thing as "free health".
I think he meant to say free healthcare. People get health and healthcare horribly confused, as Kevin does.
A problem is that most doctors dont spend any time training patients in self management. They should.
The "natural health providers" whom Kevin complains that people dont mind spending $70 on, generally do spend time helping with self management. That is one of the reasons we go to them.
Of course we "mind" spending $70. We would much rather they were covered by Medicare. Unfortunately medicare encourages people to use drug-oriented doctors rather than "natural health providers", thus perpetuating our use of massively expensive high-tech medicine.
The actual money it costs for most natural treatments is a fraction of what it costs the state to subsidize high-tech investigations, treatments, further treatments for the side-effects of previous treatments and so on.
The type of medicine mainly encouraged by societal institutions is that promoted by the mega pharmaceutical giants, for their benefit. Until this rip-off is corrected we will have a spiralling medical funding crisis.
Promotion of inexpensive approaches and commonsense & common and garden medicine for 95% of our illnesses needs to be adopted. But the wildly exaggerated messages of corporate medicine/big pharma hold legislators in thrall. Maybe Kevin too.
Posted by Ironer, Friday, 28 October 2005 6:38:56 PM
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Mr Pittman highlights a number of problems facing our health care system, but unfortunately his solution, the introduction of 'price signals', will not help with the majority of them.

For example, Mr. Pittman highlights the problem of our aging healthcare workforce. Introducing price signals will do nothing to help, since Mr. Pittman's solution is entirely demand-side while the problem is supply-side. A reasonable supply-side solution would be to train more health professionals.

Similarly, Mr. Pittman's price signals are not going help reduce the inclination of patients to sue their doctor. That requires increased doctor proficiency and better patient education on the likely side-effects of treatment.

Price-signals may help with regard to minor complaints (minor cuts etc) though since Mr. Pittman's first "main problem" for health care spending concerns the increasing rate of "incurable, though often managable" chronic diseases, nickle-and-diming on "minor complaints" is unlikely to make much difference. More broadly, price signals do nothing for people with chronic diseases since they have no choice but to seek treatment. Mr. Pittmans's price signals simply make the cost of treatment more expensive to individuals which would adversely affect the poor. Having said that, without price signals for chronic diseases, Mr. Pittman's solution is useless.

Mr. Pittman is quick to disparage the Medicare Gold initiative but completely fails to acknowledge the ticking time-bomb that is the government's 30% private health care rebate. This silly piece of policy is fraught with all kinds of moral hazards and quite frankly, its a wonder Mr. Pittman doesn't address it. Perhaps in his next article?
Posted by sjk, Saturday, 29 October 2005 8:53:40 PM
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As a public healthcare worker in Queensland, being a non-doctor and non-nursing, although woking alongside them, I can see incredible inefficiencies happening, wasting what diminshing public funds exist. So I agree with comments made by some, about making the system more efficient. Don't go spending more funds on highly skilled helath workers that sit back, baffling themselves. There is a need for balance, and at present it is too costly.
Can I suggest that our Governments take a look at what other countries around the world are doing in facing the same health funding issues, and of course that is to include health promotion. Our Governement should take a look at Germany. I understand that Germany probably best addresses the issue of the failing medicare funding, by not means testing, but co-payments made for first opinions, full payment for second, but free health care for chronic conditions beyond 6 months. There must be other solutions other than further taxes, in what is probably the most taxed country around.
Posted by AndrewC, Monday, 31 October 2005 10:50:30 PM
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With my previous message, regarding Germany's Health system, some of my facts probably are not right. More research last night showed me that Germany's system is highly aclaimed, being based on a work-sponsored insurance / social responsibility system. The Health insurance in part, combined with co-payments funds the system. Safety nets exist for those unable to afford the ongoing costs, and the unemployed as I understand it, have their healthcare funded by the Government.
The point I wanted to make though is that other countries have progressed their financing of healthcare systems beyond what we seem to be able to. Is our Government looking beyond the boundaries of taxation? It doesn't seem to be.
Posted by AndrewC, Tuesday, 1 November 2005 10:26:07 PM
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Then dental system here is 3rd world imho, if your on a pension you still need to pay get a grip in the uk they dont pay a cent and can go to any private dentist were all being sucked in while we pay for the trainee's not the government next time u walk into a public dental hospital its dead as a doornail were is all our money going ? discusting in this country we pay for dental bad enough living on the dole
Posted by maddawgz, Sunday, 27 November 2005 9:38:17 PM
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