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"...public opinion deserves to be respected as well as despised" G.W.F. Hegel, 'Philosophy of Right'

health reform: John Dwyer on « Previous | |Next »
October 8, 2007

Public opinion polls consistently place health at, or near, the top of any list of public issues important to voters. It has taken them a while, but each of the major parties has broached the topic of health.They have done so in a way that leaves much to be desired since electoral politics overrules health care reform, given the present dysfunctional "system" is constituted by a series of fiefdoms and is characterized by a large number of adverse events.


The real reform need is to reduce the emphasis on hospital care and shift the focus on primary care so as top lessen the number of people going to hospital. That understanding of health policy is not rocket science, is it? Public hospitals have major problems because of ever-increasing demand, under-funding and shortages of health professionals.

John Dwyer, University of NSW professor of medicine and founder of the Australian Health Care Reform Alliance says:

It is madness that states get more money from the commonwealth if they have more overnight admissions to hospitals It costs $750 a day to lie in a hospital bed before you get your first aspirin and much, much more in an intensive care unit or an emergency department. We need better community care. Seventy per cent of the hospital admissions of older Australians who are in very poor condition could be avoided if there was effective community intervention.

We need to swing the healthcare system around to prevention and maintaining wellness and early diagnosis. Half the diabetics in Australia don't know they have diabetes. (Most) people who are going to have a heart attack don't know they have high blood pressure. Countries like New Zealand and Canada have markedly reduced the demand on hospital services by investing in better primary care. It is intolerable in Australia that you are five times more likely to die prematurely from a preventable illness if you live in Sydney's outer west than on the north shore.
The continuum of care that should link primary, community and hospital services is made all but impossible because of the inefficiencies associated with the great divide, and the political buck passing, between the Commonwealth and the states.
| Posted by Gary Sauer-Thompson at 9:36 AM | | Comments (6)


Menadue, who chairs the think tank Centre for Policy Development, says that another core problem is a 19th-century workforce structure.

We have about 300 nurse practitioners in Australia. There should be thousands of them substituting for the work of doctors. The biggest contribution Tony Abbott could make to improving the efficiency and quality of health care in Australia would be to tackle the biggest restrictive work practice of all. The dividends would be enormous for the country.

This workforce stuff is a real reform need.

the problem of adverse events should not be overlooked. There there are far too many mistakes in hospitals-- some of these can ruin people's lives and occasionally kill them.

In Queensland,for instance, retired Supreme Court judge Geoff Davies, who reported to the Beattie government on the Dr Death scandal, found a "culture of concealment" that allowed Bundaberg doctor Jayant Patel to continue practising even though his botched operations were killing people.He said that inadequate budgets meant that there is inadequate health care and so there was quite a lot to conceal.

As we know state governments manage health in terms of crisis. The politics of hospital care is that state governments typically throw everything at cases that make it into the media whilst ruthlessly covering up those that don't. So normal practice is a routine failure to disclose mistakes or adverse events.

Carol Nader, the health editor of the Age, has an article where she agrees with Dwyer's argument.She says:

The best way to ease pressure on public hospitals is to stop people from going. And one way to stop people from going to hospital is by reducing preventable disease. So many hospital admissions are avoidable. Governments know this, yet still little of the health dollar goes to prevention. Lifestyle-related conditions such as obesity and diabetes lead to other medical problems that can mean a long and expensive hospital stay. Treating people out of hospital is better for the patient and makes economic sense.

In addition to hospitals, the ingredients to a good health system are strong health promotion and primary care. The experts say that ideally hospital services should be better linked to health care in the community. The states have long complained of patients filling hospitals because they can't get access to GPs and of elderly patients clogging hospital beds.

Peter S,
The Queensland Quality and Complaints Commission, which was set up under this Act, is investigating the deaths of 38 patients believed to have died from negligence or catastrophic failures in the medical system. Medical staff are facing criminal prosecutions over two of the deaths. With only seven of the 38 investigations finalised, more prosecutions are likely.

The Health Quality and Complaints Commission is a watchdog that was set up in 2006 after a health systems review by private consultant Peter Forster. It followed health inquiries by Anthony Morris, QC, and Geoff Davies, QC, who revealed major flaws in the system highlighted by the Bundaberg Hospital tragedy.

The deaths were among 5067 complaints fielded by the independent Health Quality and Complaints Commission in its first year.Not all complaints were about failures in hospitals, with 1600 mostly minor grievances with private medical practitioners and dentists.

The details are filtering out during Queensland parliamentary select committee hearings into the commission's first year last week. It's an argument for public accountability.

With reference to adverse incidents. The Australian Commission on Saftey & Quality in Healthcare and its forerunner have done the basic consultations with the States, consumers and professionals and workshoped various guidelines to be implemented nationally.As far as I know implementation has not happened.Why?

From all accounts Australian hospitals are no safer than they were when the first hospital safety report was published in 1995.

The Australian Commission on Safety & Quality in Healthcare has been plugging away. It still is developing a national strategic framework in which the many quality and safety initiatives in the states and territories might operate coherently.

We need a system that both measures quality and safety, and provides financial incentives for safer care.