Modern health care system at risk of collapse without reform

Dr Ian Scott, Director of the Department of Internal Medicine at the Princess Alexandra Hospital, Brisbane, takes a close look at some of the financial, structural, attitudinal and other problems facing the medical industry.

Foremost is the increasing availability of new medical technologies and the high costs they incur.

"Contemporary medicine has much to its credit, but has created an insatiable demand for new technologies and more health services," Dr Scott says.

"New medical technology...underpins more than a third of the growth in health costs over the past decade."

In addition, Dr Scott advocates stricter guidelines for interventions and operations that carry a high risk of adverse outcomes or a low rate of success in extending patients' lives.

"Decisions about the order of priority for subsidising interventions should be made on the basis of cost-effectiveness analysis and the relative population burden of illness and disability attributed to the target disease", he says.

He recommends patients be made more responsible for their own wellbeing, and that those who do not engage in health-risk behaviour be made eligible for Medicare and private health care rebates.

However, Dr Scott urges the medical workforce - rather than patients - to take a lead in debating the merits of Australia's approach to medicine.

"A change of thinking is required. Only mass action and public advocacy by practising clinicians will achieve lasting solutions," he says.

The Medical Journal of Australia is a publication of the Australian Medical Association.