January 22, 2008
A key question in health policy is whether Australia's public health system can deliver safe and good hospital service given the current hospital structure and imposed budget constraints? Bundaberg, with its deaths and injuries, implies no. The Labor governments, state and federal, say yes, despite the shortages of hospital beds, shortages of doctors and nurses, the lack of funding for primary care. Public health, they say is now commonwealth as well as a state issue and co-operative federalism will ensure adequate patient health and safety.
It is a good question to ask in the light of the forthcoming Australian health care agreements. As Geoff Davies pointed out in an op-ed in The Australian on January 16 ('Patients risk death in our sick hospitals') these agreements:
are based on the assumption that all all Australians, irrespective of wealth, are entitled to free hospital care and treatment, including operative treatment; not just emergency care and treatment, but also elective procedures. What has not been considered, and what politicians have so far been reluctant to consider, is whether that assumption is a realistic one.
The quick and dirty response is that under a neo-liberal mode of governance, it is not a realistic assumption. A two tiered health system will develop as it has happened in education with its dual private and public systems. We already have a public and private health care system with the public one starved of funds under the Howard regime.
Geoff Davies acknowledges this possibility:
It is possible that, in the end, the only realistic choice may be between, on the one hand, a system that provides can provide free hospital care and treatment of all kinds to all people, but only inadequately seriously risking patient health and safety; and, on the other hand, one which can provide a safe and adequate system but not to all categories of people or not to of all services presently promised. But the possibility of that choice is open that politicians have, so far refused to confront.
Have they? Haven't we by default actually got the former kind of health system? The services are limited and rationed, and as adverse events in our public hospitals is the norm, this health care is unsafe and inadequate. What hasn't happened is politicians publicly admitting that the system cannot provide free health care delivered safely and adequately, and that they have failed to provided the resources to ensure a safe and adequate free public hospital system.
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Gary,
When this article came out others responded with international comparisons showing Australian hospitals rank in the top 3 worldwide. The US has slid to twentysomething over the past few years. From memory I think the rankings were preventable deaths per million and France came first.
What's the system in France?