Lets Save Our Collapsing Health System

We are now hearing daily stories of the effects of our collapsing health system. Increasingly, delays spent waiting in ramped ambulances in our public hospital driveways are leading to unnecessary suffering and in some cases, death.

The response from our politicians is to shift blame between the Prime Minister and Premiers over whose fault it is and the taxpayer is caught in the middle, believing that our public hospital system will protect them and offer them what they need in their time of need.

The problem is not new, multiple reviews have been arranged and yet no solution seems forthcoming. In addition, it should have been predicted and planned for. In my home state of Queensland, we are told that everyone wants to move here and it’s a positive that our population is growing. But while the numbers are increasing, so too is the age of the population and this brings with it an increase in the burden of chronic disease as well as demand for health services.

It is lamentable that previous State Governments felt that pulling down older public hospitals and replacing them with new ones that had fewer beds was a good thing to do (despite the protestations from numerous professional groups saying this was a mistake). But this cannot be undone so we must learn from our mistakes and make sure no future government does a similar thing in a misguided attempt to try and rationalise the provision of an essential service.

Like with everything else, there are two sides to the health equation, supply and demand.

The most obvious solutions are expensive. Increase supply is to build new hospitals which are fully staffed and provide added beds to meet the need. Other supply can be added by increasing capacity and the type of service offered at existing hospitals. Freeing up supply by better use of hospital beds, such as getting aged care patients into aged care facilities rather than in acute stay beds, is also an option.

Overseas experience tells us innovation and technology can increase the amount of treatment that can be provided as an outpatient in suburban hubs or in people’s own homes. This is useful but data also exists to show this has a finite limit before early discharge can result in inadequate treatment leading to re-admission.

Increasing demand is the other part of the equation. Where possible this increased demand needs to be managed as we know that in a “free” government funded system, demand will always rise to and usually exceed supply.

We have seen the TV commercials advising us to only use the emergency department for true emergencies rather than issues able to be handled by our GP and this is a valid point. There are studies suggesting that as many as 30% of emergency department presentations are non-emergencies, but our frontline doctors also report that this may be exaggerated and the vast majority of people presenting, need to be there. How can we make sure we achieve the best usage of our emergency departments?

Firstly, if we want people who are suitable for out of hospital treatment to use those facilities, then something urgently needs to be done to make accessing general practitioner appointments both affordable and available. This is the purview of the Federal Government and the Prime Minister needs to acknowledge the problem and start offering solutions.

It is no secret that Medicare rebates have not kept up to date with inflation nor the cost of providing medical services and this runs across the entire gamut of service providers. For some people, the cost of going to see a general practitioner, even if they can get an appointment in a timely manner, is such that they prefer to present to the local public hospital and wait, knowing that any blood tests, scans visits or referrals to other specialists will be “free” without needing to pay any extra. This situation needs to be addressed.

Whether it is by changing the Medicare rebate system, opening out-of-hospital treatments to receive some form of rebate from private health insurance or subsidising general practitioner clinics to provide service to those most in need and without the ability to pay at a subsidised rate, something needs to be done. The public hospital system as it currently stands, simply cannot meet the needs of every Australian, even though as taxpayers we are entitled to free treatment in our public hospitals.

While the public system is struggling, there are reports private facilities are being underutilised or even sitting idle. Notably, a number of private maternity units have seen such a decrease in utilisation that they have closed while the public units in the same areas continue to struggle to meet demand.

Surely it is time for the Federal Government to bite the bullet and effect real change to bring affordability back to the private health insurance industry.

Private health insurance used to be comprehensive like car insurance. If you had insurance it covered everything, there were very few products available but people were reassured that if they had private health insurance and needed to use it, their condition would be covered and the rebates paid by the insurance policy would be enough to cover the cost of accessing the service.

Today, not only do 75% of the policies sold specifically exclude a number of conditions, but the rebates have also not been indexed to the recommended retail fee charged by most providers leaving consumers trying to access the private insurance policies with large out-of-pocket expenses.

This is further complicated by some medical providers charging way above the industry standard (Australian Medical Association recommended pricing) meaning it is difficult for patients to make an informed decision about how much their insurance will cover.

A coordinated effort and real cooperation between State and Federal Governments is needed.

A total overhaul of how we pay for our health system is needed.

Until these issues are resolved, families will continue to needlessly suffer, standards further erode and the morale of the dedicated staff working in the health sector further fall.

If nothing is done, it will surely only be a matter of time until someone utters the most feared of all words “means testing” and our universal healthcare system, which is the envy of the rest of the world, becomes just a beautiful distant memory.

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