An excellent piece, head and heart working well together. Let us take the focus off doctors and hospitals and put it on people and health. Peter Baume's recent piece didn't quite say that, but it's the right start.

A much larger bucket of money that is generally spent very foolishly and often not for the government intended purpose is all the various parental allowances.

These funds should be redirected to fund better health care - which would address many of the cost issues of young parents.

But, this would not appeal to many lefties

Public institutions are almost invariably less efficient than private ones. That is why 'scaling down' private health care is a misguided solution. How do you scale down a private institution anyway?

Clearly the author has an socialist axe to grind.

Bruce, if it’s lefties who would object to stopping the buckets of money being thrown as electoral bribes to families, why is the Coalition in government, and why are most sections of the welfare lobby vehemently opposed to middle-class welfare taking precedence over welfare aimed at the poor? More lefties than conservatives strenuously object to the current patchwork of un-targeted family payments.

Alan Grey, this is not the place, nor is there room, for a general discussion on public v private efficiency, so I’ll stick to one specific point. Private hospitals are more than acceptable in many cases, but depend on rapid throughput to make profits. In general, this means surgical cases. If you are unfortunate enough to come down with a severe illness which calls for nursing, medication, and most importantly, prolonged treatment, and for which surgery is not indicated, a public hospital is the place to go. Preferably a major teaching hospital.

Private hospitals make no secret of the fact that medical cases aren’t as lucrative as surgery, and they’d prefer such cases be treated in the public system. A point which was made very clear to me by Prince of Wales Private Hospital when, after surgery in the private section, my mother got septacaemia (not linked to the surgery, but part of the same illness). They told me straight out that because this would take a long time to treat, she’d be better off in the public hospital, even though she was covered for private hospital treatment.

This seems to indicate that we continue to need public hospitals. Private hospitals are, and will presumably remain, simply an adjunct.

Bruce,
It would appeal to many lefties, if the family allowances that make it possible for low income families to survive remained in place. There seems little point to me in increasing health care, and the expense of the food budget. Low income families have been screwed into the ground for the previous 23 years, we are unable to absorb any more.

The wealthy want tax cuts, we want services, if the wealthy get their way, as is probable under this government, we will see the introduction of beggers on the street, much like south-east Asia.
We will be there in our tattered clothes, cap in hand, watching the parasites drive past in their beamers. Yes "the new right" are all wrong.

Professor

Thank you for a timely and well argued paper.

You are spot on re Indigenous Health Issues and Mental Health Issues.

I have worked for the public and private sectors of health (disease) systems in Australia - some 30 or so years.

I will never feel safe in a private hospital (and I have been a patient in several). Most of the so-called nurses, are nursing assistants without any nursing education (get 'em off the street and train them like a monkey. A monkey can be trained to deliver and exit with a bed pan - it's the analysis of the bed pan that is of optimum importance).

Medical officers rarely write comprehensive reports, and RNs play a cow tow game.

"Clients" and doctors set the rules - all based on the dollar.

Nursing in private psychiatric hospitals is the greatest joke of all. "Oh yes, I am suicidal, but I do need my Chardonnay tonight".

Professor, I was once a nurse academic. I left the "pseudo" fold on the grounds of honesty - for myself and people with potential mental health problems.

I predict that miacat will be your next poster
Cheers
Kay

This thesis is more than timely, it is almost too late to turn around the health policy machinery in time to prevent a wholesale health holocaust.

This is akin to the global climate change debate. Alarmed professionals are reading the dire warning, sounding the alarm bells.... but are unable to turn around a locked-in culture that is inhibiting the reforms that Blind Freddy can see are needed.

We all know about child obesity and bad diet and what that means for the health of our nation in 20 years time, yet all of the funding and policy focus is locked into last century's thinking and appeasing 'sexy' health sectors that are already advantaged, over-funded and even, by default, encouraging bad health.

The private system may be more efficient at performing certain outcomes (elective procedures), but is not necessarily so when measured in broader acute medical care outcomes. Ignoring the fact, for the moment, that by far the greatest cost-benefit ratios are found (initially) in spending on primary health care (smoking bans, public school food regulations, fair industrial relations policies), the private system, unless bound by regulation, will be opting out of providing less profitable health care services (aged care, non-procedural). Per dollar spent, efficiency (based on only certain initial outcome measures i.e. no. operations done etc) will be greater in private but those savings will eventually become absorbed into the profit margin as shareholders expect growth. We can see this partly in the repeated request for elevation in premiums, and regular refusal of care for those patients requiring less profitable acute non-procedural care in the private system.
There is a role in private health care for elective procedures which would not be a priority in a public system but we cannot expect it to take responsibility for all health outcomes which will never be "profitable". If this is the case then it should be a strictly user-pays private system with no ongoing financial support from tax-payers and have some clarity where there currently appears to be none