President's Blog, Monday 20 July 2010
The AMA has called for health policy to be the top priority in this Federal election. We have supported the push for health reform, but it has to be the right health reform. We have to build on what works and fix what doesn’t.
The Government has invested more than $7 billion of new funding into the health system. We welcome this significant investment but question how and where some of this funding is being directed, with the plan for care for patients with diabetes being a prime example of getting it wrong.
The AMA wants to see more detail of the reforms, we want to see evidence of more hospital beds, we want to see genuine support for family doctors, and we want to see clinician input to public hospital decision-making at the local level. We would prefer a single funder for the health system.
We need to see strong policies and funding for mental health, aged care and Indigenous health.
What do you think? What are your priorities in health for this election? Please post your comments below.
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Health reform
Until the twin demons of obesity and smoking are tackled, "reform" will only nibble around the edges. We need the politicians to commit to banning the manufacture, importation and sale of all tobacco products with the arguable exception of nicotine replacement therapy. We need a taxation regime for trans fatty acids. We need a reasonable taxation regime for high calorie junk food. Given the current race to the middle, with populist policy (no boat people, no work choices) dominating the current election campaign, we are not likely to see any reform directed at improving outcomes.
The exclusion of the AMA and nearly all doctors' learned colleges from the Diabetes advisory group is evidence of that.
The only "reform" Gillard/Roxon are interested in is excluding doctors from practicing medicine, cutting costs, and taking over State responsibilities to more easily foist their own idealogical war on the practice of medicine. There is no genuine commitment to improving patient outcomes through helping doctors to do their job. The Coalition have a golden opportunity to be brave and make a difference. They might alienate a few people but they may pick up right thinking and concerned people from the middle ground who want to see real health outcomes and might applaud a courageous policy or two.
Health Reform, ethick, politics
Both of the major parties have provided ad hoc solutions to systemic health care problems : their vision has tended to be populist and has neglected important primary prevention policies that can be applied through maternal/neonatal health, liquor licensing, taxation of both toxic recreational substances and high gi foods,and more universal screening. The liberal party shall never receive my vote: their refugee policies during the Howard era were egregiously racist and the advertisements sanctioned by the current leader were crude, inflammatory and amoral. I have previously enquired if the brief of the international criminal court applies to discriminatory behaviour contravening the UN refugee convention and if Howard, Ruddock et al could be prosecuted. Unfortunately , they can't.
We need the detail
We know we need reform of the health system. We know we need Doctors meaningfully engaged in the Governance.
We need the detail.
Steve Hambleton
Priorities are generated by values
Underlying the priorities of whichever party gets into power at the next election are the values held by the leader and members of cabinet. Writing in the Sydney Morning Herald in May, Leslie Cannold provided a useful summary of some of Mr Abbott's beliefs and values, giving us some idea of the priorities for health and welfare that he would take in government:
"(Tony Abbott)is associated with groups that are opposed to legal abortion, dying with dignity, stem-cell research and gay rights. These include the National Civic Council, the Lyons Forum, the Endeavour Forum and the Australian Christian Lobby… Abbott recently described Aboriginal welcome to country ceremonies as a "genuflection to political correctness" and "out-of-place tokenism". However, he believes Federal Parliament should continue to start the day with the Lord's Prayer… When health minister, Abbott's statements and policies on abortion renewed national debate about the issue. He described "the fact that 100,000 [Australian] women choose to end their pregnancies" as a "national tragedy" that left a "legacy of unutterable shame". The figure of 100,000 turned out to be wrong. Abbott voted against legislation allowing Australian scientists to do research using embryonic stem cells."
Jill Gordon's comments on Tony Abbott
Whilst Minister for Health Tony Abbott demonstrated that his personal beliefs did not preclude him from being a very effective leader in a difficult portfolio. He was approachable and sincere and he has the runs on the board. I do not share your paranoia Jill. The Liberals proposal on Mental Health is way ahead of anything that Labor are offering. Let's hope we dont have to endure another three years of erosion, decay and patch-ups in our public hospitals.
Health promotion and chronic illness
All major medical bodies in this country have agreed that general practitioners who give health advice and see patients with complex problems need to do long consultations and should be better rewarded.Currently it is short consultations that are better rewarded and as published in the latest MJA ,long consultations are rapidly dwindling.When long consultations dwindle so does the opportunity to be able to care for those with complex problems appropriately and also there is no time to give health advice.
The Health Minister says that she is supporting both better health and long consultations and she is doing no such thing .Worse still, her subservients are continually investigating the doctors who earn less by doing long consultations so as to provide the best care for their patients.It is no wonder that as many patients are now consulting alternative practitioners for long consultations rather than seeing their general practitioner who is only rewarded for short consultations.This off course is ideal for the Government as they then pay less.
Medicare reimbursement
Why is a GP's or physician's time more valuable than a surgeon? We see complex patients often not requiring surgery and spend more time than many / most GP's and some physicians in certain situations. We need a fair time based remuneration for seeing patients without the current Medicare disparity.
As a patient or customer....
Myself and many of my friends and relatives are constantly frustrated by the semi-mystical and elevated status of health services and practitioners compared with other industries and trades. That is a debate in itself but I do believe that it exacerbates and perpetuates some issues that otherwise stand in the way of conventional commercial or industrial efficiency measure and techniques.
That is, things that are common place in the commercial and industrial process world I find are often absent from the medical world because.... Well, frankly I have no idea but I suspect it’s got a lot to do with Dr Pesce’s recent comments at the Press Club luncheon where he said that sometimes doctors just do stuff because they always have.
As members of an advanced western society, we have been subjected to constant change and restructure for decades now in the name of efficiency and economic benefits. Some say we’re getting tired of it hence the re-ascendency of “bigger” governments but the medical system seems to me to be way behind the rest of us and what we’ve had to put up with.
Change takes investment, up-skilling, re-skilling, new machinery and tools. Successful change also takes time so I would like to see a larger portion of the health budget invested now on changes like E-health records, greater preventative care programs, rationalisation and better management of skills (leave the higher risk problem’s to the higher skilled people and vice versa). Invest in giving the line workers the tools to make them more responsible to the customer or patient and let them get on with the job.
We’re sick of buck-passing between the front line (doctors and nurses), middle management (hospitals) and senior management (bureaucrats). An investment in another hospital bed may help someone today but it’s not much value if we have to close the ward around it next month because we’ve run out of budget due to wasteful spending.
Even though you take a swipe
Even though you take a swipe a doctors it seems you agree with Dr Pesce's comments at the National Press Club when he called for doctors on the ground to be engaged in the reform processes. Having those on the frontline actively involved in decision making about the most efficient use of scarce health resources is sensible and in your terms commercially prudent. Health care is not like other industries. It can certainly utilise some of the measures other industries employ to gain efficiencies, but it needs to do so being mindful that it effectiveness of service, not efficiency of service that matters. Others outside health care can fall too easily for the effciency model and the cost/benefit analysis of or production. But again the essence of health care is not primarily about the quantity of production, but its quality. Unless we have doctors and nurses on the boards of the hospitals in which they work, or one the boards of the area services in which they work then the decision making can too easily be captured bu others who bring a usefull but not intimate knwledge of health care to important governance decisions. The mere fact that doctors want to get involved speaks volumes for their level of commitment and we need to harness this for the good of the system.
Its more fun when we disagree but I'm glad you support my point
Sully, I indeed agree with Dr Pesce's comments and viewing his Press Club speech is what prompted me to comment.
In fact, I’m pleased to see by your reply that we’re largely on the same page but in one area we obviously disagree. As a developer and manufacturer of products for many years, I would not be able to afford the time to debate this subject if I didn’t strive to produce good quality products first and foremost.
Quantity and increased volume is what we strive for to increase efficiency and economic returns but not at the expense of quality if you are interested in retaining customers and staying in business. However, I have never operated in a monopoly or relatively closed market with little competition.
I think you will find that I actually supported your very summary about the need for direct administrative involvement by the practitioners. However, your point re quality and the implication that health services are superior in their requirements to other products or services could be seen as a confirmation of my first point.
Once we define what a minimum quality standard is, there really is little difference between the two... or am I talking from a different level?
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