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The Forum > Article Comments > The great health divide > Comments

The great health divide : Comments

By John Dwyer, published 10/3/2006

Where will we find the political leadership to take us on the health reform journey?

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Where will we find the political leadership to take us on a health reform journey? Not from the current bunch and not in my lifetime!

State/federal and adminstrative structures are dysfunctional and self serving.

Doctor shortages remain a problem. Even any reforms that might for example extend medicare benefits to non doctors is compromised by a genuine shortage of profesisonal in all disciplines.

With respect to nurses pay, the problem has as much to do with the numbers at the bedside as it does the money paid - this is true in the acute sector and more so in the aged care sector - nurses complain more vociferously about work loads than remuneration - most want to be able to do their work thoroughly and safely. - it is the pressure of work as much as anything that saps their morale and energy and causes many to walk away.

A gaurantee for nurses that they can come to work confident that there will be enough human resources avaialable for them to work in an environment that assures not only the safety of their patients but themselves also has the potential to draw people back to the job.

Dwyers case against the dominance of the fee for service arrangements has been raised before and usually sinks like a stone in the face of opposition by the medical lobby.

Major reform will take political will - some may argue the current government has what it takes and might point to the IR changes for example - in spite of the negative publicity and the plethora of reasoned arguement that the reforms were palpably unfair - the reforms went through.

I would contend however that we now have a less unified worforce and a bunch of unions with no clout. Add that to the coalitions command of numbers on the senate the Government really took on a pretty soft target - the lobby of vested interests represented by health administrators, public servants and the medical lobby will not roll over so easily and I doubt that they will be taken on.
Posted by sneekeepete, Friday, 10 March 2006 9:43:34 AM
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Yes, the health system needs reform, but what Professor Dwyer and Sneekeepete understand by the meaning of the word "reform" is probably not the same as the majority of Liberal parliamentarians.

I have heard one Liberal parliamentarian suggest that Australia needs a user pays health care system. If you have cancer that's your bad luck. It's your problem and your responsibility to look after yourself.
Posted by billie, Friday, 10 March 2006 10:04:21 AM
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We need less money on:
plant beautifications by councisl

indigenous land claims, wasted money on programs
money away from multicultural departments
illegal immigrants
iraq war
africans coming here for aids treatment...

all sorts of crap we shouldnt have to pay for

more on:
education
traineeships
health
nuclear bombs
police...

good forum and information here
http://www.stormfront.org/forum/forumdisplay.php?f=38
Posted by hoppa, Friday, 10 March 2006 4:15:54 PM
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Cut the dribble on Health Care! Nurses and Doctors who cow-tail to the multi-proned-cultural-denials-just to keep their own jobs...degrade any real efforts to enhance empathy with structural and practical change, for all.

Ie: 1) Medicare... a few months ago, a private practice charged Medicare $58 for a vitamin B injection...Is this a correct billing or a rip-off?

2) Many citizens (I believe) are flown by the flying doctor service out of rural areas to be judged-assessed and classified by MH services in larger townships... do not necessarily need the "crisis-care", away from their immediate-support networks.

Figure This: The Justice Order.

The cost of Staff (Police and Health Staff), Food, Board and "attention"... the cost of questionable Medication... and the fuss encountered until returning them back to a community ...

A MH_Health Tribunal (hearing one ) and more often another Tribunal Hearing (two) -Legal Aid alongside the engagement of associated officials, to prepare the way to the Mental Health Court... wow... I figure some $100,000 (so far) at least on just one (individual)... who apposes the ITO - MH medication treatment ... prehaps with good reason!

Think of the many local community programs that this sort of money could be spent on... alteratively... to encourage the engagement of a community... in the prevention of Mental Health...

Reasonablity.... where is it? Section 14 of the MH Act... 'patient can't see their own illness'... How do we protect those who have understanable "life contributing difficulties" that are not directly associated with "MENTAL ILLNESS" and who may need instead some strategic practical assistance?

I am not referring to those who do need critical; "care", I am saying directly... many persons entangled in the Mental Health System are "stero-typed" and "labelled", being forced to enter a "cycle of legal conflict" rather than care... to free themselves of the drastic measures presently offered by this "insane" MH system. It makes me mad just thinking about it...!

Maddness is a reflection of a diverse society, to cope we require support options that go further than 17th Century utterances of conventional notions, beliefs and hackneyed mono-expression.
Posted by miacat, Saturday, 11 March 2006 4:23:37 AM
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Surely the fundamental problem is that in a finite world the resources required to provide the health system that people want are unlimited. As a result, politicians all over the world engage in humbug and prevaricate over health, as that is the only realistic option. There are only so many doctors, nurses etc., and those that are here are being enticed by other countries to move overseas to fill shortages there. As the population of the west ages, and as it becomes more unhealthy through obesity and lifestyle, demand for health services will rise to the point that only the rich can afford them. There is no magic bullet. Welcome to the 21st century. With the profound reduction in living standards that we can expect from the end of cheap energy these problems can only be expected to get much worse. We have been living in a golden age.

To end on a more positive note, I read in the Christian Science Monitor some months ago their assessment of world medical services.

Their judgment on the best in the world was:

1. France 2. Sweden 3. Australia
Posted by plerdsus, Saturday, 11 March 2006 8:46:02 AM
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John,

State and Federal governments working together? Now there's fantsay.

Even when State governments are the same colour as Feds they don't get on. It's the perfect formula for both sides as they simply point and refuse to accept responsibility. Unless we reform the political/voting system there will be no change, except for the worse.

This user pays rubbish is great if you have plenty of money. Clearly the direction of all our governments has been to aim costs at the largest group, the middle to low income earners. To such an extent that Howard now controls the budgets of many families by making them dependent on welfare. Note that politicians pay very litle for the services they use.

Workforce shortfalls are a fallacy really. It has been created by governments that do not provide sufficient study options and deliberate underfunding. What good doctor or nurse would stay where they do the work of more than one person. Rather than a skills shortage we have simply pushed many qualified people out of our system as it is not sustainable to work the hours they are required to.

Many specialists have essentialy priced themselves out of the market to such an extent we see regular appeals on TV from desperate people who can't afford to be saved.

The private health care system is a rort. Since Howard donated the 30% discount to people by paying these funds directly their fees have gone up by 30%. Total waste of money. Close them down, pool the money and allow private health care for those that pay the lot, no assistance.

Health has suffered essentially the same as most of our infrastructure. Governments have focused on "making profits" by squeezing the life out of people simply to be able to boast they have surplus budgets. Yes they do but people are dying both waiting and in hospitals with people like Dr Patel.

Where will this user pays crap end? Will they start "putting down" people who can't afford to be treated? Seems logical doesn't it, it's economical.
Posted by pegasus, Saturday, 11 March 2006 8:59:23 AM
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What is community engagement?

John you said above, "Workforce shortfalls are a fallacy really. I agree. "It has been created by governments", governement who miss the point when it comes to the value of national and state innovation and research, or as you said governments, " that do not provide sufficient study options and deliberate underfunding."

I believe it is a failure in Australia's understanding of Sustainable Development. I believe this is because It is a Under-Development.

If there is one thing I am truely proud of in Queensland. It is the UN-Brisbane Declaration policy for "Community Engagement" 2005 signed last Augest.

This is because of the polices such as LA21 are bound through Agenda 21 (World Summits New York 2005 updated from RIo 1992). This policy is strategic, it is a deveopmental economic policy which now stands as a UN policy which highlights on the value of "community engagement", and the necessity of "civic participation through the help of NGO representaions, and focus on ground level engagement..

We need health and employment to be present in community.
Posted by miacat, Saturday, 11 March 2006 11:25:54 PM
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I've just joined and read this article and appreciate all the comments. Sadly as is always the case with nurses and Qld Health there is little real discussion. I wonder why that would be? There is very little in Gay's article that makes real sense to me as an RN suspended from the workplace due to criminal allegations from ex-colleagues and facing the criminal justice system for the first time. A system I might mention here which is as inefficient as Qld Health. The bottom line is that we nurses have been screwed for years by the government and because of our "culture" have allowed it. We're are all the voices from the struggling?
Posted by stevo, Sunday, 12 March 2006 2:38:58 PM
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The AMA is the most powerful union in OZ. It is time they take some responsibility for the shortage of doctors as they help set the quota for students. It is the current climate of user pays that is really threatening, not only in health services but also in training the next generation.
Hands up those of you who have been to a not too bright doctor and wondered how they managed to pass (Australian drs too). Full fee payment for uni places are going to deliver us more poor quality, but wealthy, doctors.
Nursing training needs to be taken back into the hospitals, at least in a sandwich uni hospital course. Hospital training of nurses means that the student nurses are paid while they study and contribute to patient care at the same time.
The health crisis is a politically manufactured problem.
Posted by Aka, Sunday, 12 March 2006 5:24:59 PM
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Is hoppa for real!
Nasty
Posted by Aka, Sunday, 12 March 2006 5:28:02 PM
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Of course we will find the leadership from the Federal Health Minister Tony Abbott, who with his collegues cut State Health funding by nearly $1 billion in 2004, and the mighty AMA, the doctor's Union, and yes the most powerful Union in Australia.

It would seem to me that more doctor's are not being trained even though the government has ample funds to do so {projected budget surplus $17 billion} because of some nod, nod, wink, wink, say no more understanding with the AMA so as to keep doctor's incomes at the high rate at which they currently are {apologies to bulk-billing doctor's for whom this is NOT true}.

On the reverse side we have Workchoices for the balance of the working population, to drive incomes down, hee, hee {to compete with the rest of the world hee, hee} ah yes an arguement for every situation, typical tory politician. When will the sleeping Australian wake up and realise it is all a smoke and mirrors, decade of fear politics of division. Australians have always managed much easier when united.
Posted by SHONGA, Monday, 13 March 2006 3:43:02 PM
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Aka,

I'm assuming you meant "the AMA is the most powerful (medical) union in OZ". Even if that is what you meant, that wouldn't be true. It doesn't function particularly well as a union, which it isn't. And as a political body (which it is), is finds it difficult to represent doctors as a whole because of the fragmented nature of the specialist vocational groups within the medical workforce. The AMA's input into workforce planning isn't as significant as suggested, with each specialist college tasked to assess and train numbers for the specialist workforce (now essentially including general practitioners).

On the issue of overall quality of health provision vs global standards, there needs to be a fundamental shift in society's expectation for medical assesment and treatment. Pressuring politicians over 7 hour waiting times in the emergency department for conditions that individuals have the capacity to see the GP for the next day (and yes, I am taking into account those without capacity to pay in rural areas with no bulk-billing GPs)is a sign that expectations have overshot the mark. The gut reaction has been to punish emergency departments.

We cannot as a country afford expensive health services in which minimal health outcome benefits are obtained at the expense of more efficient spending in areas such as provision of basic services (basic education, vocational education). Continue to stengthen the PBAC so that drug prices are negotiated well and inexpensive (and sometimes expensive) cost-effective drugs are subsidised at the expense of expensive pointless drugs.

At some point in the evolution of segments of our health system we have to admit to adequate outcomes then assess the health of the health care workers to see if they need help to make it sustainable. Keep improving resources available to the struggling health areas but for gods sake question any policy in which public subsidisation of private health sector leads to nothing more than poorer public service and what appears to be a zero sum game private health care sector.
Posted by PSP, Monday, 13 March 2006 5:37:12 PM
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Jut try getting into Medicine as a mature-aged student. And once (if) you get in, you'd better have strong family supports to get through the course, and a free place to stay.

Medical university places are highly rationed and highly sought after. The UMAT test is basically an IQ test with unvalidated components such as 'shape-matching' - ACER confirmed to me that they have done no validity testing on this at all. (I got 91st percentile - top 9% - on the IQ/logic part and about 30th percentile on the shapes. Anyhow, undergraduate mature-age places are deliberately rationed or disallowed at all Australian universities, even if you do well overall.)

I will now spend a year swotting for the GAMSAT, although you need a minimum credit average in your first degree, and, once again, it all gets a bit ridiculous.

I was accepted into a Masters in Nursing Practice, but dropped it for a variety of reasons, some to do with the obvious 'politics' of Nursing vs Medicine - there are too many lines of demarcation, strongly lobbied for and jealously guarded by the AMA, and only some kite-flying suggestions for breaking down some of the barriers. Who knows, though, it may happen. One day.

Further, I know that I can make far more money in my first career of IT than doing Nursing.

Prof Dwyer, I read your book 'The Body at War' some years ago, and loved it, and it gave me some impetus towards trying to work in healthcare in a rewarding and challenging role. My other loves are sociology and philosophy, somewhat away from the pragmatics of health science...
Posted by Sean, Thursday, 30 March 2006 9:56:37 PM
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