DANGEROUS OVERCROWDING IN A BRAND-NEW PUBLIC HOSPITAL

The "free" public hospital system in Queensland is one of the world's oldest. So it has had lots of time to show how such systems end up -- as bloated bureaucracies where patients are just an inconvenience. The hospital mentioned below is brand new and much bigger than the one it replaced. Its corridors are filled with staff -- but doctors and nurses are rare

DANGEROUS overcrowding in one of Queensland's largest hospitals is at tipping point with emergency specialists vowing to leave patients in ambulances on the ramp outside. A leaked internal memorandum describes pandemonium in Brisbane's Princess Alexandra Hospital, due to a chronic shortage of beds in intensive care, coronary care, mental health, general wards and the chronic overloading of the emergency department.

Princess Alexandra Hospital's emergency department director Phil Kay and nurse unit manager Julie Finucane sent the memo to Queensland Health executives after a crisis meeting with specialists and nursing staff. The memo highlights how serious problems in Queensland's health system are also acute at major teaching hospitals in Brisbane due to undersupply of hospital beds and staff shortages. "Declarations of danger by qualified emergency specialists trained in the field have been over-ridden by non-clinical administration personnel who on almost all occasions have not attended the emergency department to see for themselves," the memo says.

"The senior nursing and medical staff can no longer tacitly support this system of allowing the facility to become so overloaded and crowded that basic safety standards are unable to be supplied by the organisation. We have been forced to unload ambulances into corridors where there are no or inadequate nursing staff and no ability to visually monitor patients. In the opinion of clinicians this has already contributed to one patient being found moribund who subsequently died.

"Patients will be left on trolleys in (ambulance) care either at triage or on the ramp but outside the emergency department work area until a safe treatment area can be found for them."

The above news item appeared in the Brisbane "Courier Mail" of August 6, 2005





MEDICAL CARE FOR CASH IS A BIG SUCCESS FOR ALL

Tremendous savings by eliminating bureaucracy and paperwork. I go to a general practice like that here in Australia. I pay $45 per visit to a very knowledgeable and pleasant GP and later claim the cost on health insurance -- who give me back about $30 of it

Dr. Brian Forrest thought he'd probably take a pay cut when he opened a family practice in 2002 with plans to quit accepting health insurance, charge half what most doctors do and increase the length of patient visits. Instead, the practice is thriving on $45 office visits and Forrest, 33, earns more than he did while working in urgent-care centers. He prefers not to disclose his income, beyond acknowledging that he nets significantly better than the median annual net income for primary care doctors nationally. That was $161,816 last year, according to the Medical Group Management Association, a national professional group.

The trick? The practice, Access Healthcare, sees fewer patients and charges less but collects 100 percent of fees, which are posted in the lobby for all to see, from patients at the time of service. Nationally, medical practices collect less than 70 percent of billed charges, according to research by the association. And to collect even that much, practices must invest in costly computer systems and employees dedicated to handling insurance matters, such as preauthorizing care, filing and refiling claims. That increases overhead and cuts into profit.

Insurance-free or "cash" medical practices such as Access are still a rarity, but Forrest and others see that changing when the advantages -- for both patients and physicians -- become more widely known. Physicians can earn a good living while giving patients time and personal attention. Patients with or without health insurance can get quality health care at an lower cost.

The trend to reduce health insurance premiums by shifting to policies with higher deductibles, may make practices like Access even more relevant. A patient with a $1,000 deductible, for example, is going to be responsible for the majority of day-to-day expenses. That person is going to want the kind of value a low-overhead practice can provide, Forrest said. At Access, cholesterol tests are $25, a finger splint is $15 and a school or camp physical is $25. "For primary care, I think in five years, this is going to be the predominant model," said Forrest. Last year, he recruited a nurse practitioner, Sara Hubbell, to help meet rising demand for care. And Forrest is planning to open a second Triangle location within a year, though he hasn't decided where.

Last month, Dr. Douglas Keith, a Raleigh physician who owns urgent care centers in Garner and Durham, opened an insurance-free primary care practice in North Raleigh. It's a much more cost-effective way to run a medical office, he said. A standard patient visit in his urgent-care clinic costs $115. At Keith Medical Center, the insurance-free practice, it's $50. "At the Garner clinic I have to see 30 patients a day to break even," Keith said. "Here, I need to see 5.6 patients to break even." So far, about 90 percent of Keith Medical Center's patients are uninsured. Only about one in four of Forrest's patients is uninsured, though initially, he expected to see far more.

Forrest found patients with insurance are willing to pay out-of-pocket for the personal attention his practice can give them. He and Hubbell have the luxury of spending 45 minutes or more with patients, if they need to. Many insured patients file claims with their insurer on their own and receive partial reimbursement. "People tell us it's worth it to them, even if they have to pay a little more," Forrest said.

Source

***************************

For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

***************************