We want what we have always wanted, service {doctors and nurses} enough to provide a service, more training places made available in Australian Universities for same.

And private Emergency rooms, for private patients, at private hospitals.

A good public system, fully funded to be the equal of any in the world. Howard has $15 billion in the bank, let him spend some of it on Medicare, and State public hospitals, and increasing Uni places for doctors and nurses.

Hi Shonga,

Why the private emergency room...just wondering. I would have thought given the shortage of doctors this would only spread them thinner? I think just increasing doctors at one emergency centre would be more beneficial to all.
Cheers

What I want is four-fold.

Firstly, a yielding of the closed shop by the medical profession. Someone with four years training and a couple of years supervised experience can do much of what our precious, cossetted doctors can do at half the cost. All that is needed is for nurse practitioners to have enough common sense to refer on situations that are too difficult for them to diagnose or deal with. The present Rolls-Royce system denies access to many, and cossets the rich. Can we have a medical Toyota system instead?

Secondly, I want to see expenditure on illness care split rationally between hospitals, nursing homes and services that support home care. There are thousands of people occupying hospital beds who need not be there. Everyone knows what to do to fix this. Why aren't we doing it?

Thirdly, I want to see more effort go into HEALTH care, as a preventive strategy to illness. As part of that we might do something to reduce the incidence of illnesses and deaths caused by the health system itself. Can we put more fences at the top of the cliff and fewer ambulances at the bottom?

Finally, I want to see the byzantine funding labyrinth: federal, state, private insurance, government health fund subsidies, tax rebates and the rest, all rationalised.

We are paying too much and receiving too little.

I have just had an interesting few months healthwise, which serves to indicate the importance of preventative measures.

About 8 years ago, my PSA had gone up to nearly 15 and my then GP told me that if I didn't immediately have an operation to remove my prostate, then within 2 years I would be in a bad way, possibly approaching death. I told him that I was going to treat myself with supplements. He read the riot act to me and got my wife on one side and nearly scared her to death. He told me to go to Fremantle hospital and have a biopsy "and maybe you'll listen to them if you won't listen to me".

So I had a biopsy and this showed that cancer was present in my prostate. When I discussed my decision to use supplements to control it, the Fremantle hospital doctor was totally different to my GP. He said that he respected my decision and congratulated me on being so well informed.

I am very health and fitness conscious and had been taking minerals and trace elements, antioxidants and multi-vitamins for years. For my prostate, I added a product containing saw palmetto and other herbs. Everything I took was approved by the TGA.

Until recently my PSA level remained about the same and I had no symptoms of prostate trouble.

Then a few months ago I tore a muscle in my chest mixing cement in a wheelbarrow, a notoriously awkward job. When the pain got worse instead of better, I went to a physiotherapist. She started by telling me how amazingly fit I am for my age [72 in August] and told me that I would be OK in a few weeks. Unfortunately this did not happen and she was puzzled as to why.

To be continued.

Then I had a touch of flu which seemed to leave me unnaturally weak. I went to see my GP [a different one] and he took blood for testing. My PSA had shot up to 296 and I was sent for a full body bone scan. This showed that the cancer from the prostate had seeded into my bones in various places, particularly in the area of the torn muscle. So now we knew why the pain in that area was not responding to treatment like it should.

The GP told me that, due to my very healthy lifestyle, the cancer was non-aggressive and slow moving and nowhere near as widespread as was customary. He sent me to see an oncologist, who also congratulated me on my fitness level and said my healthy lifestyle and the supplements I was taking had held the cancer back for 8 years. The oncologist gave me some tablets and within two or three days, the improvement was remarkable. I had more like my usual energy level, the frequency and urgency of urination, both during the day and at night, dropped back to something like normal and the pain in my chest and back disappeared.

I went to see the oncologist yesterday and feel pleased with what he said. I had an injection which takes over from the tablets and lasts 3 months. And he doesn't expect to need to see me again until June.

To me, one of the most significant things is that my GP and physiotherapist approve of me taking supplements and the specialist is particularly approving.

It looks like I will need neither an operation, chemotherapy, nor radiotherapy. So I've saved the health system a fortune. But I have to pay GST on my supplements and many health professionals would have told me that I was just wasting my money.

If I ask you,what is your income?But if I want to know how much is of your health.You can answer my first question in terms of money per year,but for second question such direct answer is not possible.So,a better measure is yet to be developed for health to say.

To the Author

Thank you for your timely and well thought through article.

I have done my utmost to write, implement, and evaluate primary health care principles and philosophies. I have taught nurses and medical practitioners and other health professionals for many years. Similarly, I have taught clients/patients.

Nurses and medical practitioners in the main are not interested in prevention and early intervention - well, at least from my experience.

On the other hand, clients/patients and their carers, and allied health professionals have mostly shown interest.

Interesting
Cheers
Kay
PS: Hi Shaun

There is an assumption in the broader community that if we throw enough money at any given problem it would go away. This is all well and good apart from the fact that those that espouse the 'money will solve it all' solution do not, themselves, step up to the plate and offer solutions that would obviate their own inclusion in the problem's solution.

I do not know of anybody, given the academic requirements, that would be refused entry to a learning institution in their endeavour to achieve what people on this forum want.

What then do we do? Lower the standards that we demand of system of medical treatment? We could achieve all the above desires if we imported thousands of doctors such as Queensland's experience with Patel. We could flood the corridors of even the most remote hospitals with health 'professionals' of suspect credentials.

Private rooms? My God, what level of sanctimonious expectation do we have when people advocate that private rooms for patients should be an expectation of health reform? 20 plus million private rooms available in case all the population became ill is a wonderful way of spending the medical dollar.

The most pressing problem in today's society, as I see it, is not the failure of a system but an unrealistic expectation of its abilities. The enormous costs of ever developing technologies come at the same enormous price tags. We demand acknowledgment and treatment of illnesses that compound daily yet we remain devoutly ignorant or what that cost is in real terms.

If the general public wants the biggest and best of health care, regardless of cost, then we should also be willing to increase taxes and subvert welfare to do it. A budget surplus is evanescent at best, the willingness of the population to perpetuate the funding of these services is what is important

It's good to see citizen engagement in health issues raised and let's hope we can have some more specific comments focused upon your article.

You put forward the 1999 Consensus Conference as "great example" of citizen engagement. Yet how is success evaluated? Whilst the dozen or so participants in the project may have gained a great deal and enjoyed the process what was the impact upon public policy? What did the process add to the development of gene technology policies and how consumers are today engaged in the science and technology? Such one off initiatives can be time and resource hungry and are unlikely to be repeated unless there is evidence to demonstrate their value.

Consumer participation in health planning and delivery seems woeful in many states. Although there are some high level strategies the reality seems to be that most politicians, policy makers and health planners do not percieve increased citizen engagement as the way forward.

Life expectancy is considered as measure for health for a country and compared between countries indicate which country is forward and backward in health care system.Is advancement of medical care only indicative for longer life expectancy?I want comment on this question.

DR PRABIR

I could not understand your first post, let alone your second. Sorry.

Cheers
Kay

Kalweb

Let me now enter to the question raised.We know USA is highly devloped in medical care system.But it is found that Spain and Singapore are ahead of life expectancy when compared with USA.Am I clear now?

Hi Dr Prabir,

You asked me about my income. That's between me and the Taxation dept, but, like most Australians, I'm neither rich nor pennyless. If you're wondering what I spend on my health, then it's considerably less than what many people spend on tobacco, expensive alcohol, endless cups of coffee, gambling, junk food, expensive restaurants and business suits [for instance].

I'm a freedom of choice person and don't concern myself overmuch on what others choose to do. I have a great social life, out dancing 4 or 5 times a week. I like a glass of wine, but I don't have expensive tastes. And I enjoy a bit of fast food, but I don't live on it.

But the many people who deliberately or negligently ruin their own health and then expect the health service to pick up the pieces are going to be an increasing problem. We can't deny them treatment and understanding, but where is the money supposed to come from? My solution is to tax the things which we know are likely to have a bad effect on health and have no redeeming features and put this money straight into healthcare. But this would be a politically unpopular move and we're not likely to see a bipartisan approach, because the pollies are too busy trying to score off one another to put Australia's interests first.

And I think a realistic approach to the cigarette problem amongst young people would be to tell the kids straight that if you smoke, then you will carry an unpleasant smell about with you. So what's glamorous, macho or sophisticated about that? And as for the people who sell/supply cigarettes to young people, then they are like paedophiles. They take advantage of young people to give themselves a benefit. Set them up and prosecute them. It shouldn't be too hard.

As for the US having an average life expectancy lower than we could expect. Maybe that's because many US citizens can afford neither health insurance nor healthcare. Something which could happen here too if we don't do some realistic planning.

To Rex
Yes,life style affects health.But the point is whether an average American drink,smoke or other unhealthy lifestyle as personal issues compared to a Spanish or Singaporien;so,lifespan shorten or some things else are responsible.Much more thoughts are necessary.

Dr Prabir,

The United States has the most expensive health system in the world and far from the best. The World Health Organisation's annual report in 2000 assessed comparative performance of health systems in 191 countries, http://www.who.int/whr/previous/en/ The systems were assessed according to a range of factors, including disability-adjusted life expectancy (living in a coma for a year was given less weight for example than living for a year while mobile and of sound mind).

The United States certainly did not come top (France did - those cheese-eating surrender monkeys must be doing something right). However it's nowhere near the bottom.

You would be slightly better off in the United States (at number 37) than you would be in Cuba (39). Now that's something to be pleased about. No wonder all those Cubans have flocked to Florida.

However if you're not happy with the American system, you'd be marginally better off in Costa Rica (36), better still in Australia (32) or Canada (30), or substantially better in Morocco (29) or Israel (28).

Patchy coverage with health insurance in the US was considered a major negative factor. Insurance cover by employers is a historical accident, dating back to the second world war when wages were frozen. Offering health cover was adopted by many companies as a tool to attract staff. But now no political party has the resolve to fix the problem.

The 2006 edition of the OECD Factbook has just appeared at http://miranda.sourceoecd.org/vl=2249570/cl=14/nw=1/rpsv/fact2006/

It provides a wide variety of statistics for the 30 OECD countries on population, economy, environment, prices, energy and other topic areas.

It reports the United States as being fifth worst for infant mortality out of the 30 countries and offering the nineth shortest average life expectancy at birth. Not much of a credit to the US health system.

To the extent that Australian politicians are tempted to follow in US footsteps, I'd suggest: don't.

Australia ranks sixteenth out of 30 for infant mortality and fifth for life expectancy. In both it ranks slightly better than Canada and the UK, other countries from which we might be tempted to borrow ideas.

Health is psychological and social wellbeing;emotionally stable and able to cope with life(Blaxter 1990) though it is positive approach but that is not the end in itself.
The question regarding the state of health in the life process of an individual in living a satisfying life and contribution of health in economic growth and development may be raised.How one can keep oneself healthy and the factors that intervene state of health are inseparable issues.Economists would be more interested to analyze and understand the interplay between health and other variables ie.interconnection between health and productive process.Health may be considered as capital asset ie.leading a productive life.
So,health does not mean only medical care system of a country.Medical care facilities is a small part of total health care system.

Life expectancy is the measure for public health care and medical care for purpose of to be cured when ailments.Ofcourse vaccination is also a medical care to get free from particular disease.Public health care keep people not to be affected by various diseases.For poor and developing countries the priority is of public health care
because which enhances life expectancy.Rich of poor and developing countries can avail medical care facilities available in developed countries.Life expectancy observation within developed countries show shorten and differ in life expectancy in comparative study due to the reason often public health care do not reach to a greater part of population.So,factors influencing the health are equally important as medical care.

DR PRABIR

Thank you for your posts. As a nurse committed to primary health care, I find your posts very interesting.

Cheers
Kay

Kwaleb
Thanks for your support.Nutritionist,Agriculturist,Veterinarian and Teacher etc.also contribute in higher life expectancy.Ofcourse no way it is less contribution of medical doctor.