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The Forum > Article Comments > Only fundamental reform can save our health system > Comments

Only fundamental reform can save our health system : Comments

By Fiona Armstrong, published 1/10/2007

The current dysfunctional structure of the nationís health care system poses a risk to the health of Australians.

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Trained Medical Practitioners

What has caused the problem of staffing Public Hospital and the wider community with qualified medical practitioners?
 The funding of our Universities in order to create additional places.
 Universities have become reliant on Full Fee Paying Students from overseas, who once qualified often return home.
 The Commonwealth Government in consultation with the States have failed to establish the number of Specialists that should be trained each year by our Medical Colleges in order to meet the nationsí needs
 Standards been set for Foreign Trained Medical Practitioners.

Foreign Trained Medical Practitioners

It is the Commonwealth Government who should not only set the standards, both in qualifications and matters pertaining to National Security, but who should be responsible for verifying a person qualifications and issuing a security clearance.

Why the Commonwealth? Before a Foreign Trained Nurse can practice nursing in this country that person must undertake an english test and meet the requirements set by the Australian Nursing and Midwifery Council. State Governments do not set the standards.
Posted by southerner, Monday, 1 October 2007 10:29:13 AM
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"Responsiblity" Yes! Begins with the sharing of knowledge, vital local and national discussions with the help of well written articles like this one.

Thank You Fiona, please help us ALL - please keep writing.

I find the health issues are hard to argue because there is not enough debate involving stakeholders at community level.

In my own community (Cooktown in Cape York) Health is a POWER STRUGGLE at the mercy of PARTY POLITIC's. LOCAL Party politic's and forms of structural violence (silo) within the local and district health system has abused the "COURAGE" of this community, which used to stand for univeral values, with greater interest at the center of the forum, proudly.

SPEAKING OUT ON HEALTH IN COOKTOWN CAN HAVE YOU LOCKED UP + I AM SERIOUS.

Local Nurses are divided on process and issues in Cairns and Cooktown and the consumers movement (Cairns) very muched out of reach, with it's own issues of leadership and prioity. Far North Queensland is UNDER_RESOURCED by all definations to cope with the real strategies necessary to face the social-economic challenges underlying health and community well being now and in the future.

We need to LEARN TO ACTION inclusive strategies the most.

And I agree "dysfunctional structure of the nationís health care system poses a far greater risk to the population than the actions of the Reserve Bank to keep a buoyant economy in check".

http://www.miacat.com/
.
Posted by miacat, Monday, 1 October 2007 10:29:21 AM
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There is another way of tackling the problem that will lead to more efficient expenditure. Do not distribute money for non emergency medical services except through patients themselves. Rather than the government giving money directly to health services or indirectly through health insurance schemes give the money to individuals who in turn pay for the medical services when they need them. The difficulties have arisen because it is not the people who need the services who pay for the medical services. Give everyone money each year to use for health services. If people do not spend it in any given year let them keep it for use in future years. Require everyone to spend some of their money on health insurance for large emergencies but for everyday health needs give everyone some money that can only be used for health. If people go beyond the amount of health money then they have to pay for it themselves. People will be careful with their money and most will tend to save and most will shop around for health services to get better value for money. Still have safety nets for chronic illness and accidents but give expenditure control to people themselves and make it worth their while to get the best value for money.
Posted by Fickle Pickle, Monday, 1 October 2007 11:25:37 AM
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Australia has to decide whether we want a publicly funded universal health care system or whether we want an American style privatised health care system.

Our current system subsidises private health insurers, private hospitla building owners and private hospital operators. The private health system is attractive to shareholders of Ramsay, Symbion, mortgage trusts who purchase the hospital buildings and overseas insurers like AXA who own HBA.

State governments have renovated public hospitals and sold them to private owners.

In Victoria hospitals have outsourced the staffing of hospitals. This has led to the owners of nursebank purchasing the most expensive house in Toorak and caused the directors of hospital boards to re-evaluate their relationship with Nursebank

There is no reason why public servants can't operate an efficient universal health system more cheaply than a privatised system owned and operated by "for profit" providers.
Posted by billie, Monday, 1 October 2007 11:52:42 AM
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Fiona,

Your advocacy of Labor Party policy comes undone. You compare what Labor says it will do to what Rudd says it will do.

Rudd said if the states don't get the hospitals in order then he will take them over. That implies the states have a problem with running hospitals.

Rudd's into apportioning of blame for the state of hospitals while you show an exact opposite Labor 'announcement(s) about health reform aimed at reducing the blame game'.

Why the discrepancy? What will we actually see? A continuation of the Labor states blame game with Rudd? Most likely since Labor never takes responsibility for any stuff up.

Labors rhetoric on the subject is, as you repeat the mantras, long on words short on detail....

'As recognised by Labor, a national health reform commission is also required,'...

or put another way. More billions spent on another level of bureauracy looking into things and issuing reports.

'...removing the inefficiencies between different levels of government, and focusing the system on prevention and health promotion ...'

Wonderful...exactly what inefficiencies and how are they to be removed?

'Only by eliminating the opportunity for cost and blame shifting can we have truly accountable systems that are transparent, evidence based, and use resources efficiently.'

Really this begs the question and it needs to be addressed: why aren't there transparent accountable systems now...they were there once?

'...the current dysfunctional structure of the nationís health care system ...'

As for a system... the currently a system is not dysfunction as you claim. It's called funding. It is allocated by the Federal Government annually and negotiated by states on a lump sum basis. They have for many past years been responsible for spending that money. What is dysfunctional is where that money is being spent and, as you correctly point out, there is a 'lack of truly accountable systems that are transparent, evidence based, and use resources efficiently.' in the state jurisdiction.

Under Labor's generalisations would everyone then be truely accountable and transparent?... given the discrepancies in the rhetoric and past form, not bloody likely... ooops probably not.
Posted by keith, Monday, 1 October 2007 12:18:33 PM
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Hi Fiona, I am interested in explanations for the problems and your article certainly adds to that. In my view the problems at the Royal North Shore Hospital, Sydney - and many others - are a combination of several factors only one of which is the unsatisfactory hospital management style. However, there are three external political conditions that cause the sad outcomes common to many other hospitals. These are (a) the huge fiscal imbalance in federal-state relations (b) the electoral system (c) aspects of the Westminster system. The financial imbalance in the federation is a major cause (discussed in OLO earlier). Secondly, Australia's single-member district system creates safe and marginal seats. Safe seats, such as North Sydney, are at a disadvantage while pork barreling in marginals is part of the same problem. Thirdly, the Westminster system, which requires that Ministers are "in and of the Parliament", produces functional amateurism. This is not the exception. It is the norm. So don't blame Health Minister Reba Meagher, a young labour lawyer, blame the system instead. There are many such examples. Vanstone and Scully come to mind. Do the once politically neutral and professional public servants come to the rescue? Alas, that was the practice. All these problems can be fixed but don't expect much from the major parties. So whom will you vote for now? Who offers system change becomes the really important question. The structure of government and the electoral system are in urgent need of reform. We need candidates and parties to come forward who are system changers. Major party candidates are system reinforcers.

Klaas Woldring
Posted by klaas, Monday, 1 October 2007 1:59:26 PM
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