Tuesday, March 07, 2006


I have three brief news items below about shortcomings in the Australian public health system and also below are two longer articles. It all does help to explain why nearly half of Australians have health insurance that enables them to go to our many excellent private hospitals rather than the overstretched public facilities. The trouble is that lots of Australians still believe the lie that the politicians have been telling them for years -- that everybody will be given as much "free" medical care as they want or need

Why did the Australian taxpayer EVER fund this stuff?: "Patients seeking facelifts, breast and penile enlargements, tattoo removals and liposuction have been banished from the waiting lists at NSW public hospitals. Instead, the 2000 patients awaiting nip'n'tuck cosmetic procedures will be forced to shop around private health facilities to have their operations. "Unless there is a legitimate medical reason, I don't see why NSW taxpayers should be funding these types of surgery," Health Minister John Hatzistergos said. "Most cosmetic surgery should ideally be undertaken within specialist private health facilities. "By reducing clinically unnecessary procedures, doctors will be ensuring more surgery time for people with real health needs," Mr Hatzistergos said. The new elective surgery policy will be announced today by Mr Hatzistergos in a dramatic move to streamline waiting lists and give priority to patients queueing for procedures such as hip and knee replacements, cataract removal and gallstone surgery".

Who cares about the patient in a public hospital? "Vital tests to check for bowel cancer in at-risk Victorians are being secretly cancelled and cut back, surgeons and specialists claim. Investigative colonoscopies were postponed indefinitely by some hospitals last month and scaled back by others, worried doctors said this week. The surveillance procedures are done on Victorians who have a family history of bowel cancer or are considered high risk for other reasons. Surgeons said the procedures were postponed indefinitely at Box Hill, Maroondah and Angliss hospitals in mid-February and scaled back at several others. A specialist said: "People are being left in purgatory -- their procedures are being postponed indefinitely." The surgeons' claims have been backed by the Cancer Council Victoria, with director Prof David Hill saying he had received similar reports. "We are hearing at the coal face that this is happening," Prof Hill said. It is believed cash-strapped hospitals have chosen to drop colonoscopies because it allows them to save money while also appearing to have maintained their care standards".

Roadside births soar as wards close: "The number of roadside births in Queensland has soared as maternity wards shut their doors across the state. Thirty-six of Queensland's 84 public maternity wards have closed over the past decade - coinciding with a 70 per cent increase in roadside births since 2001. Latest Queensland Health figures obtained by The Sunday Mail reveal 277 babies were born on the roadside in 2004, up from 162 three years earlier. Lobby group Maternity Coalition state president Bruce Teakle said women were having to travel up to 1000km to have a baby. "It's a huge concern - it's not good enough that on average five women a week give birth on the side of a road," he said. "Women are travelling further in labour, and that means more roadside births. "It's something that can be very distressing, and it's just not a good start to family life".

Up to 1300 Australians per year die waiting for public hospital help

Up to 1300 Australians die each year waiting to be treated in or admitted to public hospitals. A review of deaths at four public hospitals found patients forced to wait more than eight hours for treatment were 30 per cent more likely to die than those admitted when the hospital was not overcrowded. "Overcrowding is endemic in all large tertiary hospitals in Australia," said Peter Sprivulis, associate professor of emergency medicine at the University of Western Australia. "The situation has been deteriorating for about 15 years."

The two studies of more than 60,000 admissions at Canberra Hospital, Royal Perth Hospital, Fremantle Hospital and the Sir Charles Gairdiner in Perth found delays in treatment caused more than 130 deaths a year. "It's probably five to 10 times that amount nationally," Professor Sprivulis told The Australian. "It is well known that people who experience delays in getting treatment do worse. "For example, if a patient has a very serious infection they are more likely to die if they don't get the antibiotics on time."

Professor Sprivulis said medical errors were also more likely to occur when hospital resources were stretched. "Overcrowding is often associated with placing inpatients on an incorrect ward -- such as medical patients placed in emergency department corridors, which can cause potential adverse events."

The West Australian study, published in the Medical Journal of Australia, analysed hospital admissions via emergency departments in the three years to June 2003. It found 120 deaths a year were linked with overcrowding in the West Australian hospitals. The Canberra Hospital study looked at how many patients died within 10 days of presenting to the emergency department in 2002, 2003 and 2004. It attributed 13 deaths a year to overcrowding in the emergency department.

Drew Richardson, chair of road trauma and emergency medicine at Canberra Hospital, said further studies were needed to determine the extent of the problem. "The magnitude of the association of overcrowding and mortality in the ACT is around 13 additional in-hospital deaths annually. "That's similar to the number of people killed on the roads in the ACT each year, and if replicated in other studies, this association would represent a significant health issue," Professor Richardson said.

Peter Cameron, head of Monash University's pre-hospital and emergency trauma group, said increasing the number of hospital beds would not ease pressure on public hospitals. "Increasing the number of hospital beds temporarily alleviates access block, but does not solve the problem -- the beds quickly fill and the problems recurs." Professor Cameron said hospitals needed to find a better way to balance the dual demands of managing critically ill patients while still providing elective surgery. "Moving patients quickly from acute hospitals to more appropriate facilities increases hospital bed availability. "Access to rehabilitation, residential aged care and community outreach programs is an essential component of an efficient and well managed health system," Professor Cameron said.

He also called for better disease prevention strategies. Research had shown increasing flu vaccination uptake in the over-65s to greater than 90 per cent would reduce the need for acute hospitalisation in that age group by up to 40 per cent.


Bureaucrats bleeding the NSW public health system

The Labor Government keeps the shackles on our doctors and nurses and our whole health system is crumbling.... Where does it start? It starts with the Government accepting federal health funding and banking it straight into consolidated revenue and then failing to forward the entirety of that money on to our state healthcare system. They get away with this because long ago the Wran Labor government started voting doctors off hospital boards and kicking them out of hospital administration, working through every hospital in Sydney, and then replacing them all with bureaucrats. Then doctors in the Health Department were also replaced by bureaucrats.

This is dangerous: A bureaucrat's first rule is to look after his own, a creed which begins to explain why today there are 1.8 hospital administrators for every patient. It's why the old nurses' quarters at Royal Prince Alfred, a building that used to be full with 1400 nurses all prepared to tend to our sick, is now wall-to-wall with administrators making economic decisions about our health care. Not a nurse to be seen.

Wran's illusion of care, which has been copied by following state governments, happened so long ago that we have been conditioned to accept it. Much of what truly happens inside hospitals is never discovered because the Government covers its tracks by gagging doctors and leaning over nurses, threatening them with their jobs. "The money is not going where it is needed," a doctor whispered in this ear. "We keep telling the Government this and they keep telling us to get stuffed."

He would speak only under condition of anonymity. Why? Because doctors are gagged by the Government. Any doctor that speaks out is in danger of losing their job. Now some - just some - of the truth can be told. He said patients were being discharged from hospital three and four days after receiving a coronary artery bypass graft. Why? Because the bureaucrats need the beds to meet their bottom line. Who cares if patients still dangerously ill are being told they are ready to go home and are discharged. He said no elective surgery was booked for the days leading up to public holidays like the Easter break. Why? Because penalty rates are too severe. The only theatres kept open are for emergency and casualty patients.

Then he said 30 per cent of beds across Sydney hospitals were closed. Why? Because every bed requires three different nursing shifts and two different doctors, working 12-hour shifts each day. Along with that comes cooks, cleaners, laundry and other ancillary staff. Close one bed down for a day and the bureaucrats save around $1000. lose 50 beds down and they get a call from head office and a recommendation for the next promotion. That is the reward of the loyal bureaucrat, whose god is numbers. They close down as many beds as possible to save money while at the same time discharging patients as soon as possible to increase the turnover . . . and therefore the cash.

And throughout we suffer the great insult - a Federal Government snipping from us a portion of our salaries for the Medicare levy, to support that health system. Money, remember, that goes straight into consolidated revenue and then fails to get redistributed, in its entirety, into state health care. This is the bureaucracy we deal with in government - and it is time for it to stop.

Doctors are tired of sending sick people home early or turning them away. Recently a leading surgeon quit a major public hospital frustrated at being unable to get his patients booked in for operations. "What's relevant is that the Government will not put the money into the system," the doctor whispered.

These are grounds that the next state election should be fought on. No doubt there will be some who will consider it unrealistic, others will say the problems are too deeply entrenched to ever be satisfactorily repaired. But if you can't hope for a better, more humane way you might as well throw it all away.

More here


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?

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