An interesting article; Thank you for that.

You may also be interested in the excerpt below, from NEJM, which refers to current pediatric services in the USA.

The link
https://secure.nejm.org/ecom/register/reg_etoc.aspx?promo=ONFENR01
provides a free subscription to the NEJM e-mail table of contents and access to articles six months after publication.

It looks as though children are another significant “user group”. I wonder how our current, fragmented federal approach to health care might be specifically improved to benefit aboriginal children in isolated areas.

~-~

New England Journal of Medicine
Volume 357:1549-1551 October 11, 2007 Number 15

The Quality of Children's Health Care Matters — Time to Pay Attention

James M. Perrin, M.D., and Charles J. Homer, M.D., M.P.H.

“High-quality health care matters for all children — and is critically important for some. In many ways, health care for children serves the same function as health care for adults. For example, the incidence of chronic illness in children is increasing, resulting in a substantial illness burden with a substantial cost.1 How well chronic conditions are managed profoundly influences both short-term and long-term outcomes, not only for common diseases such as asthma but also for rarer conditions such as cancer, cystic fibrosis, and sickle cell disease.2 “

“Many aspects of children's health care have no parallel in adult health services.3 The disproportionate rates of poverty among children and adolescents mean that children's health services must address health needs despite limited resources. Because children are dependent on caregivers and community resources, providers of child health care must enhance the competency of these caregivers and coordinate a broad array of community services. Children's health care settings typically involve developmental surveillance; the identification of sensory, learning, and behavioral disorders; and monitoring for family violence and child abuse. Optimally, such programs provide evidence-informed counseling that promotes positive behaviors related to individual health, family functioning, and psychological and developmental well-being — all of which are beyond traditional health care services — with effects that last for the rest of a child's life.”

"We have free public hospitals,"

This is not correct, our public hosptial system is not free.

Now please correct me if I am wrong, but is not the reason we pay taxes to fund things like hospitals, schools, roads etc.

Introducing a level of co-payment which already exists to some degree is like saying to someone you have already funded the road network through taxation, now you must pay to use it.

Research indicates that introducing a method of co-payment will have a negative effect.

Already in many hospitals around Australia fees have been introduced to park your car in hospital grounds. The big question is where is the money earnt from the car park fees going?

The author is correct when he says we dont have a system - Similarly I make it practice to avoid the words Health and Planning in the same sentence.

One of the problems faced in health delivery is the enormity of the attendant portfolio - Abbott et al display their ignorance of the system when they brazenly blame the states for a deterioration in standards - a hard charge to really prove unlless you ardently believe the shock jocks assesment of the system based on the isolated foetus in toilet type fiasco - "foetesus happen" as they say.

Further ignorance of the system is shown by Brumby in dialogue with Victorian Nurses when he talks of productivity in nursing - that cancerous concept while shedding (appropriately useless nurse admin jobs) has crept down to the bedside - when talking of productivity in health Brumby should look to the public service

As the author points out our standards are high and costs are contained - we could however get more health for our buck - again the author rightly points out most health agencies are over managed - that is not to say they should be the exclusive playground of the clinician - ohh deary me no! but the health public service both state and federal for both their size and capacity to micromanage and waste $ are unparalleld.

I am not convinced Rudds 2 billion would make much differene but the promise of a more coordinated appraoch makes sense - he could find his 2 billion - in part - by getting rid of the 72 Premier advisers Bracks retained - then look to the public service for the balance

“Many aspects of children's health care have no parallel in adult health services" - Sir Vivor

I normally avoid engaging you but will make an exception. Once, when a member of an Apex Club, with past members on the hospital board, the CEO of the local hospital said to me "it is easy to raise money for children, but hard to find charity for the geriatrics, where the need is great".

“High-quality health care matters for all children — and is critically important for some."

The Childrens Hospital in Sydney had a team of specialised and experienced staff. But the politicians, in their backward venal outlook, put the axe through the hospital and handed it over to the profiteers for asset stripping then onto their cronies in real estate for 'developing.' This proceded under the guise of "transferring beds to the west." (Westmead Hospital)" A few years later, then there were vicious cuts to Westmead Childrens. There is a strategy being implemented. A major consideration the politicians are aware of, is that parents will go through enormous hardships for their children when they fall ill. This is fertile ground to develope and stimulate a market - private health care.
Usually the first ward the politicians (Labor and Liberal) attack and demand closed is the Emergency Ward. People can then be referred to a private surgery.

johncee1945 and others,

I think we should stop thinking in terms of parties and focus on failing Ministers. Herein, we ostracise the relevant Minister Coalition or Labor:

Given [Liberal] Tony Abbott's [Heath and the Ageing] attitude to restricting access PET scans, I would black mable him in the Ancient Greek sense, if I were a Manly voter.

Secondarily, the State [Labor]MPs should loose their Health Minister's set, for failing to their Party and failing to deal with Abbott: Wrong head on the block - but tough.

The two party system is too cosy. Let's take out poorly performing Ministers in specific electorates, even against our natural political leanings.

About four hundred years ago, in Commonwealth system, Parliament system was re-constituted to protect the People from the Monarchy. Today, we need protection of the politicians. In this frane, we should leveage what remains of democracy to eleminate poor politicians, rather than voting the party line like mindless sheep.

Heath is a big issue. Why not ostractize Tony Abbott. Surely, there are thousands of people [Labor, Liberal, Green, Democrat], who could be organised to rally against him. They can still vote for their local candidate outside of Manly, as they wish.

The above is not specifically anti-Liberal. In days gone by, I would say the about Labor Minister Dawkins wrecking our Education system.

We have to take out these Ministers and build a People's democracy.

Oliver, you cite your hospital CEO as saying:
"it is easy to raise money for children, but hard to find charity for the geriatrics, where the need is great".

The assumption appears to be that money must be raised by individual hospitals, to meet requests which the state and federal governments will not fund.

The NEJM article excerpt highlights poverty and dependency among children as significantly affecting the approaches which may improve their care. I expect the authors would allow that geriatric patients may also be poor and dependent, and subject to other key factors (and prejudices)which limit the quality of their care. The authors do not advocate better care for children at the expense of their grandparents.

What system would you advocate to assure that health care needs were met equitably, across generations?

Great analysis. We have an "illness industry" rather than a "health system".

We have to start putting the fence at the top of the cliff rather than the hospital at the bottom. To do that funding for the health system must reward primary care providers for keeping patients well rather than for curing them after they get ill.

Roll on the politicians and bureaucrats who will give us good health

Sir Vivor,

My point was identified by you. The aged find it hard to gain funding especially charitable funding, based on what I was told.
As I have mentioned in an other thread even middle-people find it hard to gain access to PET scans at a reasonable cost. PET scans can locate osolated radical cells after a primary operation to prevent occurence. Australian has a 1.1 trillion dollar economy.

"I think we should stop thinking in terms of parties and focus on failing Ministers. " Oliver.
It is not "failing ministers" nor the subjective characteristics of corrupt politicians, more than anything else today, they are the expression of a national tendency when the whole structure of the globe has became international. They are the reactionary leftover from the old national order. The globalization of production has rendered them obsolete and superfluous. Increasingly, they will turn to more brute force using the military and police. Behind the scenes they are preparing for more wars such as in Iran, and colonial interventions in the Pacific region. War abroad always means war on workers here. The politicians do not have one policy for Iraq and another for here. A similar scenario is being prepared in the US.

Johncee, re your dire prediction:
"The globalization of production has rendered [politicians] obsolete and superfluous. Increasingly, they will turn to more brute force using the military and police."

I think you're drawing a long bow here, comrade. Surely they won't beat up and imprison the entire hospital ladies auxiliary, just for running a cake stall to raise money for a PET scanner.

johncee1945,

What is not usually rewritten in Western textbooks about Pearl Harbor is that Japan had is its oil supplies threatened by the West and was militarily surrounded by China, the Durch, Britain and the US. Today, NATO, plus, Japan, Australia and India could place pressure on Iran [and their Russian alliance?]. But this has little to do with PET scanners and advanced equipment.

The above said my point is about purchasing more PET scannes and capping the cost of using them. These machines are valuable in the diagnosis on isolated cells after an primary can cell to ensure early detection. Tony Abbott has been very too slow to act. So we should act on him.

Regarding ostrasization of individuals, one could vote Liberal in a non-Manly electorate but still rally against Abbott in Manly. By targeting the poor Ministers, we can break the domination of the two party system. Its the People taking control off the politicians.

We need to be honest when assessing our health system, by looking at the underlying causes for the conditions being treated by our health system. This means judging our own society and the affects it has on individuals. Behind a lot of our behaviour which ends in affecting our health are abnormal though popular ways of coping with the stresses in our society,(drinking, being busy, smoking, shopping, eating, extreme exercise, competition, many addictions). Our society is not that good in lots of ways, especially the mania of workplaces and the pressure to get more and compete with each other. None of this encourages a healthy society, but we are stuck in it and it is getting worse, and the health service is expected to pick up the pieces from a dysfunctional society.

jillham,

When a Pych. student back in he 70s, one lecturer could not receive funding for a study into the prevention of alcoholism. He was told the money was there if the people to study were already alcoholics. Perhaps, little has changed

Two letters to today's SMH are typical of many others:

http://www.smh.com.au/letters/index.html?page=3

ABBOTT BREAKS PROMISE TO PORK BARREL FOR ELECTION

"The outlook for recovery from rectal cancer is unique for each individual. Many factors are involved, when considering the chance of survival after rectal cancer treatment.

Long-term survival generally depends upon the stage of the cancer at the time of diagnosis and treatment.

According to stage, the following approximations of the likelihood of survival 5 years after treatment are as follows:

Stage I: The probability of being alive in 5 years is approximately 70-80%. Stage II: The probability of being alive in 5 years is approximately 50-60%. Stage III: The probability of being alive in 5 years is approximately 30-40%. Stage IV: The probability of being alive in 5 years is less than 10%."

--- WedMD

http://www.abc.net.au/7.30/content/2007/s1973995.htm

http://www.abc.net.au/7.30/content/2007/s2043989.htm

Abbot did not keep his promises. Also, I understand that attempts at leveragw through Catholic Cardinal George Peel failed, appreciating this a matter of life and death, rather church and state.