"Let’s start with having a health system, not only an illness system - one that actively creates good health from birth and maximises our health to the grave."

DUH!

Now let me see. I wonder why people are vaccinated? The reason cant be vaccination stops people from getting sick and requiring hospitalisation.

I wonder why we have various food and health standards? The reason cant be to stop people from getting sick and then requiring hospitalisation.

Now I wonder why they introduced set belts and safety standards on motor vechiles and equipment. It cant be to stop people from injuring themselves and requiring hospitalisation.

We already live within a system that tries to prevent illness and injury and there is nothing new in this goal. People have been trying to stay healthy and alive for centuries.

What is happening is that we are getting better at managing incurable diseases and disorders, more and more people born with genetic disorders are living longer, where a few decades ago some wouldn't have survived past their teenage years.

This creates paradox which this CEO should know is that by keeping people healthy and out of hospital means that only the very ill require hospitalisation and medical treatment and when these types of patients make up the majority of patients in hospital, this increases demand on all available resources, and increases costs.

Another aspect which is happening is that in the last few years of a persons life, their hospitalisation rate increases. Something which this CEO knows.

An example of this is where an 80 year old male who has never been a patient in hospital, starts to require hospitalisation and over the next few final years of his life he has multiple admissions.

Labors or the Libs health care policies are meaningless.

Imagine another scenario where the 80 year old cant get admitted to hospital because there are no beds available, it is likely they will not survive without medical intervention, or become so sick they wind up in intensive care, a much more expensive option.

The author might now be an academic, but he has a solid track record in the 'real' world. His work in reducing levels of smoking in Victoria is an example.
I go along with his views, except for the implications of government bloody-mindedness on things like dental health. At the moment, if people don't care for their teeth/gums,and spend that money on other priorities, it is the taxpayer who is expected to pick up the tab. But we need to plough more money into public dental health, or more generous health insurance, so that dentists in public clinics can match the high incomes they can earn working privately.
Some dentists I know are already helping towards a solution here. They work one day per week pro bono. Perhaps more could follow this example.

The full effects from reduction the reduction in smoking will not be realised for at least another 40-50 years.

A recent conversation with a mate in middle management in health and he agreed with what I said, "Nobody in their right mind is going to tell a CEO that his plans are not going to work." Well that is if they value their job.

Many CEO's are just puppets for our politicans, and any sensible CEO is not going to tell his/her political masters that their ideas are not going to work.

Just over a decade ago I said to a certain politican that all the cost saving measures and improvements they were introducing were not going to work and that it would prove to be more expensive in the long run.

Guess what health is in a much worse state now than a decade ago. So much for improved efficiencies, cost effectiveness.

The more a hospital improves its efficiencies and treats more patients, the more expensive it becomes. It is that simple.

Mind you in the private sector it means greater profits for private hospitals, however in the public sector it means budget overruns for public hospitals.

Congratulations Rob. You have captured our health systems needs so well. But to make those changes will require new ways of preventing illness – particularly in identifying and “at risk“ treating patients. It is significant that our funding systems are all about treating the ill and not about keeping people well. To make the mind shift from illness to wellness we will have to reduce the impact of health professionals (especially doctors) in planning health services. They always move towards illness positions very quickly. Our health systems will have to become truly multidisciplinary. And primary health care will have to be much better resourced than it is now.

James H claims, in his first reply, that we practice preventative health now. We only do part of it. We arguably do whole of population education well and we do some medical prevention like immunisation tolerably well. We arguably pick up some chronic diseases like diabetes and prevent some of the complications of these diseases. But we fail miserably at some of our major preventative tasks – over 50% of Australian adults are overweight or obese and around 20% smoke. Our illness systems are not funded for prevention so it does not happen. The nutritionists, exercise physiologists and psychologists needed to turn around our health do not, for the large part, work closely with GPs and pharmacists who are well located and trained to identify at risk members of the population.

Thank heavens for Rob and organisations like AHCRA who continue to press for intelligent reform

"The nutritionists, exercise physiologists and psychologists needed to turn around our health do not, for the large part, work closely with GPs and pharmacists who are well located and trained to identify at risk members of the population."

I am surprised that naturopath's aren't mentioned, as they were the first "doctors" of medicine.
I wonder if any medical student or medical professional knows what goes on with Codex Alimentarius and it's effects on future healthcare systems
worldwide.

Albert Einstein observed that 'the problems that confront us cannot be solved by the thinking which created them'.

I am not qualified to comment on either Liberal or Labor proposals in the area of our ailing Health system. However, reading through the article and the ensuing comments I recall reading somewhere about a novel solution which prevailed (perhaps still does) in some parts of rural China.

There as I understand it medicine and health was delivered by travelling doctors skilled in Traditional Chinese Medicine (TCM).

The client pays the doctor to keep her/him healthy however when the client gets sick the doctor not only pays his patient but also provides his services and medicines at no cost for as long as necessary.

Food for thought that!

But we need to plough more money into public dental health, or more generous health insurance, so that dentists in public clinics can match the high incomes they can earn working privately.
Some dentists I know are already helping towards a solution here. They work one day per week pro bono. Perhaps more could follow this example.
Posted by analyst, Monday, 8 October 2007 10:38:23 AM

Interesting issue dental health, considering that there is a correlation between poor dental health and heart disease.

There also a correlation between dental health and miscarriage.

The plain fact is that poor dental health leads to adverse health outcomes, and considering around 67% of the Australian population earns less than the average wage it is not difficult to understand.

Improving the dental health of Australians is a cost saving measure, simply because it will decrease the numbers of patients requiring cardio-thoracic surgery for heart disease caused by poor dental health.

Ninja

Paying health professionals when their patients are well is an interesting concept and one that offers lots of potential for improving the health of our community. It was canvassed by teh House of Representatives Inquiry in to Health Funding.

The two big drawbacks are that practitioners try desperately not to attract ill patients who are in most immediate need of care (cherry picking), and it "encourages" doctors to under-service their patients. Getting GPs to buy their patients' pharmaceuticals reduces pharmaceutical bills by 10-20%. These could be overcome by the HIC using similar measures to prevent underservicing as they currently monitor overservicing.

There are considerable vested interests keen to maintain the status quo and no real demonstration of the political will to tackle the big issues.

The unfortunate message our politicians get from this is that not only should hospitals be paid for out of current funding but a range of new preventative programmes should also be paid for from the same pool.

I don't disagree with the policy objective but it does need extra money and better co-ordination between the various layers of Government. Maybe the preventative stuff could be moved into or aligned with the divisions of general practice rather than having 3 levels of agencies competing to see who can make us eat less and exercise more ?

I would think over stuffed EDs and over long elective surgery lists are the real political problems, and that one appears to feed the other.

I wonder if the daily drama of the bulging EDs could be solved by running hospitals with enough spare bed capacity to meet anticipated demand ? Would this then shift the problem to the elective surgery lists ? I ask because there seem to be some knowledgable contributors who may be able to answer.

A well argued rational proposal as opposed to the ideologically driven Jeremy Sammut article.

I ask because there seem to be some knowledgable contributors who may be able to answer.
Posted by westernred, Tuesday, 9 October 2007 1:31:13 PM

You are correct in assuming we need more hospital beds and the problem with bulging emergency departments is the lack of available public hospital beds, so while patients wait in emergency departments for a hospital bed this creates what is commonly known as access block.

Lets take an example of a hospital I know about. 60-70% of hospital admission come through the emergency department. This then has a flow on effect in that elective surgery is cancel because of 2 factors, lack of hospital beds and a lack of theatre time. (If a hospital is over budget, elective surgery is postponed).

The above factors are a direct result of budget reductions to public hospitals over the last decade or so.

If one looks at a time series of available public hospital beds from around the 1970's to now, it is easy to see that there has been more than a 50% reduction in available public hospital beds.

Australia's population has grown so apart from existing hospitals reducing their bed numbers, there has been a failure in investing in new infrastructure. Both State and Federal governments have tried various models with the private sector. By and large these models have been expensive dismal failures.

Around the time Paul Keating became Prime Minister, it became fashionable for 'cost effectiveness' 'improved efficiencies' so all the micro economics of the Keating government has led us to this point.

Hello John W and James H,

John, I was unaware that what I wrote about regarding the system of ‘wellness’ which operated in rural China had been discussed here in Oz. So thank you for that piece of info.

I was not proposing that we should adopt a similar system – it would be unworkable given the prevailing social environment. I was merely trying to substantiate Albert E’s assertion that we need to look at a problem from a completely new perspective. Perhaps this is where the problem for many of Australia’s woes lays – the lack of creative thinking by our leaders both political and otherwise. Personally, I doubt either of the major parties can claim to have the ‘common good’ as the prime objective underpinning their particular ideology.

James H, let us for arguments’ sake accept that Keating’s micro economic management model which he favoured and promoted, has got Australia to where it is in the area of Health care. My qn then is - what has Howard and Costello done over the past 8 – 10 years to reverse the situation?

The ‘Adam Smith’ model which I believe the Liberal Party favours and influences its policy platform, whilst full of promise in theory is impractical and morally bankrupt because it fails to consider or factor in that fundamental human failing ‘greed’. One example to illustrate my contention is the galloping gap between the rich and the poor evidenced in Australia since the Libs gained office in the 90s.

The ‘blame’ game which governments of all political persuasions and their advocates seem to indulge in will not help to resolve difficult problems - only maturity, partisanship, dialog and a genuine desire to serve the whole community will.

Ninja wrote:

"John, I was unaware that what I wrote about regarding the system of ‘wellness’ which operated in rural China had been discussed here in Oz. So thank you for that piece of info.

I was not proposing that we should adopt a similar system – it would be unworkable given the prevailing social environment."

I think you'll find a system incorporating some of that logic already exists in the UK, where GPs are paid more if their patients meet a range of "wellness" measures... don't know the exact details but it came up in "Sicko." It is a great idea anyway, putting the emphasis on the opposite metric to what happens here, ie, more consults = more $$. I think their system involves a set allocated number of patients per GP and the healthier that group is, the more the GP is paid.

This has been a fascinating read, thank you all!

Could we agree from the views expressed that our public hospitals could have smoothly run EDs if they ran at lower bed capacity and were prepared to effectively shift the problem to elective surgery waiting lists /times and possibly reduce the range of services, eg, no PET scanner or similar high tech equipment ?

Would that be a better way for health managers to manage the problem ? The politicians would then be left dealing with public rage at why granny is waiting 5 years for a new knee ?