Thursday, June 04, 2009

Free public medicine struggling; Australia headed towards user-pays system

And the proposed solution? A bigger bureaucracy! It would be funny if it weren't so serious. Amusing that Australia is heading towards the current American system while America is heading towards the Australian system. Australia and the USA are very similar countries so it is sad that America cannot learn from the unsustainability of the Australian system

THE Australian system of free universal healthcare is set to disappear in as little as five years, prompting a radical plan for a new federal-state partnership to take control of hospitals and patient care. It comes amid a push by the Australian Medical Association for hospital specialists to treat patients only four days a week, potentially placing further pressure on a system already hamstrung by work restrictions among emergency physicians.

In a startling warning, NSW Health director-general Debora Piccone has told The Daily Telegraph that Australia is hurtling towards a US-style user-pays system due to an ageing population and out of control costs. "We are really on the edge of losing the universal healthcare system that this country has," she said. "I would have (previously) said we'd had 10 years to run. It's now looking like we've got five years to run because the cost escalations are so significant and we haven't prepared ourselves."

Under the US system there is no free health care. Even an employer-subsidised insurance premium costs more than $3000 a year and if you are uninsured you are likely to have to pay several thousand dollars deposit just to be admitted to a hospital.

Professor Piccone and Health Minister John Della Bosca are now working on a plan to pool all state and federal health funding and have it redistributed by a joint partnership between the two governments. The $13.2 billion state hospital budget - set to grow into almost $50 billion by 2025 - would be integrated with Commonwealth funding towards Medicare, the pharmaceutical benefits scheme and aged care and jointly administered so as to slash red tape and eliminate overlap.

Mr Della Bosca said the overhaul - the biggest since universal health care was introduced under Gough Whitlam - would deliver "a single mandate" of patient care. "We need a new governance model which takes the massive pool of funds available," he said. "We need to find a forum to co-ordinate that more effectively and you can only see that as some kind of joint commonwealth-state operation. "I know the next step is right there and we've got to take it."


Increase in women doctors ‘will put strain on the NHS’

Women doctors will outnumber their male colleagues in a decade but the change is likely to place a strain on the health service, according to a new report.

More than half of all new medical students are women but they are far more likely than men to work part-time and choose specialties where they have set hours, according to the study by the Royal College of Physicians. This could lead to a shortage of surgeons and doctors in obstetrics and gynaecology, paediatrics or public health, and a need to recruit more doctors overall, the report suggests.

At present women account for 40 per cent of all doctors, 42 per cent of GPs and 28 per cent of consultants. However, they are forecast to make up the majority of GPs by 2013 and the majority of the medical workforce some time after 2017.

“Across the NHS, 43 per cent of all women doctors are under the age of 35, so many will not yet have started families,” it adds. “And the proportion of women of child-bearing age will rise sharply in the next decade as the larger cohort of women medical students graduates.”

Compared with the early 1960s, the number of men entering medical schools each year has doubled, but among women it has risen tenfold.

Most NHS doctors, both men and women, still work full-time, with only about 15 per cent on part-time contracts. But in hospitals, 21 per cent of women are on part-time contracts, compared with 8 per cent of men. At senior consultant level, 30 per cent of women are working part-time.

Only 8.4 per cent of consultant surgeons are women — and women make up only 27 per cent of those opting for a specialty in surgery.

The study adds that there are very few women working as consultants or at the top of the NHS as medical directors and very few chairing professional executive committees.

The Women and Medicine report — which follows a two-year review — said there was no evidence that women were more likely than men to leave medicine entirely. However, a 15-year follow-up of doctors after graduation shows that, on average, and after career breaks and part-time working is taken into account, women fulfil 60 per cent of the role of a full-time doctor while men fulfil 80 per cent.

Sir Liam Donaldson, the Government’s Chief Medical Officer, welcomed the report. “The NHS benefits enormously from the diversity of its staff and the ways in which they reflect the community more widely,” he said. “We will work with the leadership of the medical profession to ensure that women have every opportunity to realise their aspiration when they choose a career in medicine.”


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