BY ALISON DELLIT
After badly scalding his face, a friend of mine went to the emergency department of Sydney's Westmead Hospital at 2am, where he waited for six hours before his burns were even looked at.
Stories like this are common. Australia's hospitals — particularly emergency departments — are understaffed and underfunded. Public patients have to wait weeks, even months, for elective surgery or dental work.
Adding to the crisis in the health system is the uncertainty of doctor's medical indemnity insurance coverage. The government has been forced to step in and guarantee to protect the 60% of private doctors insured with United Medical Protection, following its collapse.
To turn further towards a market-based system will further erode Australia's health care system, taking us closer to the nightmare system in the United States where, despite spending public funds on health than in Australia, the poor and sick simply die.
How can the health crisis be solved?
1. Medicare works — extend it
Despite the federal government's best attempts to undermine it, Medicare continues to be supported by more than 80% of the population in every poll taken since it was introduced in 1984. This is not surprising. Medicare has provided universal health cover for those who need care the most but are often the least likely to be able to pay for it: the elderly, the chronically ill, Indigenous people and the poor.
From 1984 to 1998, the number of Australians taking out private health insurance declined steadily. During that time, infant mortality rates dropped more dramatically than ever before in Australia's history, and average life expectancy rose by more than two years.
Medicare delivers a better health-care system more efficiently than any private operator. While administration costs for private health-care funds average 25%, for Medicare these average just 3%. Medicare services have increased by 30% per person since 1984, while its cost as a proportion of GDP has increased less than 3%. Australia spends a lower than average amount on health care as a proportion of GDP compared to other OECD countries.
Australia's public hospitals outstrip their private counterparts in almost every respect. It's no mystery why multi-billionaire Kerry Packer chose to join the 70% of hospital patients who are treated in public hospitals.
Public hospitals deal with almost all chronic care cases and the vast bulk of emergencies — and they still have slightly lower mortality rates than private hospitals, according to the Australian Council on Healthcare Standards.
In the last year, Melbourne's four private hospitals went on "ambulance bypass" (refusing to take all but the most urgent cases) 873 times. In contrast, Melbourne's 13 public hospital emergency departments did this just 322 times.
Because private hospitals function is to make a profit, they are more likely to target profitable elective surgery over emergency care or care of the elderly.
Health care is cheaper in public hospitals. A study by RW Harper and KD Sampson, published in the September 2000 Medical Journal of Australia, found that the cost of coronary angioplasty in a private hospital was more than twice the cost of the same procedure in the adjacent public hospital — and with the government's private insurance rebate, the private procedure costs the taxpayer $1000 more than the public procedure!
On top of providing a better service, public hospitals train more health workers.
Medicare and the public hospitals work because they are geared to meet the needs of patients, not to make a profit.
The main problem with Medicare is that it fails to go far enough: "ancillary" out-patient services, such as physiotherapy, speech therapy, many "alternative" treatments and dentistry are not covered.
2. Stop public funding to the private system
Every year since 1998, the federal government has spent around $2.5 billion on the private insurance rebate, 50% of which is received by the wealthiest 20% of Australians. The government has falsely claimed this would "reduce stress on the public system", but the opposite has happened.
In 2000, then health minister Dr Michael Wooldridge commented to the July 21 Canberra Times that without the government's hand-out's "the whole [private insurance] system would collapse".
In some areas, such as heart surgery, more public money is spent on procedures carried out in private hospitals than in public hospitals. Spending on public dental care for adults is now about $180 million a year — yet, through the rebate, $330 million of government money is spent on private dental care!
Since the rebate was introduced, health funds have increased their premiums by an average of 7%, nearly twice the inflation rate — despite getting record surpluses in 2000-2001.
After the rebate was introduced, those participating in private health insurance went up a negligible 1% — the existence of Medicare, providing free hospital and basic medical care, renders private health insurance a luxury at best, and a waste of money at worst.
But the government did not give up on increasing the profits of its medi-business and insurance mates. Supported by the corporate media, it whipped up a scare campaign, arguing that as the "baby boomers" got older, health funds could not cope.
The government's hints that Medicare could be dismantled, combined with penalties for those who join private health funds when they are over 30, increased the private insurance take-up rate.
3. Increase public funding to hospitals
While significantly better than their private counterparts, Australia's public hospitals desperately need improvement. According to a report issued in August by the Royal Australian College of Radiologists and the Australian Institute of Radiology, up to 10,000 cancer patients died prematurely or suffered unnecessary pain in 2000, due to staff and equipment shortages.
A similar survey conducted by University of NSW medical staff found that half of all patients who die in hospital show serious and preventable symptoms in the eight hours before they died. The government's own "National Report on Health Safety", presented in August, said a whopping one in 50 hospital patients were harmed or killed by health-care mistakes — the proportion was highest during night-shift and weekends, times when staffing levels were lower.
The number of beds available in acute-care hospitals has been cut from 5.2 per 1000 population in 1988 to just four per 1000 in 1998. Probably as a consequence, the average hospital stay has been cut in the same period from 4.6 days to 3.7 days.
Emergency departments have been the hardest hit: Victorian government figures released in September noted a 83% increase in the number of people waiting more than 12 hours in emergency departments for a hospital bed.
Another worsening area is elective surgery, as many specialists take the more attractive money offered in the private system. According to the August 14, 1999, Sydney Morning Herald, 28% of people with below-average incomes waited four months or more for elective surgery, compared with 3% of those with above-average incomes. The waiting list for physiotherapy is six weeks for public patients and just 24 hours for private.
Yet just $600 million dollars could eliminate all public waiting lists in Australia!
If the money spent on the government's private health insurance rebate was pumped back into the public system, it would make a huge difference. According to the Doctors Reform Society, this would pay for a 10% boost to hospital funding (enough to reduce waiting times in emergency departments by more than 66% and ease the pressure on elective surgery), the aged-care budget and Aboriginal health spending (enough to save thousands of lives).
Enough would be left over to fund a dental health scheme for the elderly and people on low incomes, and to add millions to the rural health budget, as well as preventative and primary health-care programs.
Imagine what could be done if the government increased corporate taxes.
4. Close the wages gap — support health-worker pay claims
While many specialists are earning considerable incomes, the majority of workers in the health system have appalling wages. This has led to a shortage of nurses in public hospitals (exacerbated by the decision of several universities, including Sydney University, to cut nursing places in favour of profit-making courses).
A report released by the Australian Centre for Industrial Relations Research and Training (ACIRT) on May 21 found that 1700 nurses had recently left the profession as a result of under-staffing and poor wages.
Lynn Hopper, a clinical nurse in the public health system told ACIRT: "I look at my peers in other professions earning big bucks and I think of myself — decades of experience, a degree and several certificates, managing a ward and 30 staff with a budget of several million dollars and I get paid less than $50,000 a year."
Recent pay claims launched by nurses in a number of states, including Tasmania, Queensland and New South Wales, along with the pay rises sought by other health workers in Queensland, could begin to turn around the low staffing levels of nurses and help to rebuild the hospital system.
5. Replace medical indemnity insurance
Under Australia's litigious system, many of those seriously injured during a medical procedure can only get enough compensation to treat their injuries by suing a specialist doctor (this system does not apply to public hospital doctors, who are covered by the government).
If a doctor is found to have made a wrong decision, they may be liable to pay the enormous costs involved in the upkeep of someone who had been permanently disabled. Because of this, all doctors must take out insurance against such claims.
But since insurance companies (or medical defence organisations) operate to make a profit, doctors pay through their insurance premiums anyway. Premiums for the highest risk work — neurosurgery and obstetrics — are as high as $120,000 a year.
The patients, and the federal government, then pay the extra charges through the specialists' fees. The end result is that delivering babies begins to become too "risky" to continue: patients cannot afford an obstetrician (or even midwives, who are not covered by the government if they work out of a hospital).
This system needs to be replaced with one which recognises that necessary care for the seriously injured is a public responsibility. Some, including Australian Medical Association president Kerryn Phelps, are calling for the government to look at implementing a "no fault" insurance scheme, where all patients injured during medical procedures or in hospitals could be compensated. Separate criminal or civil proceedings for malpractice could be taken against incompetent doctors.
Such a scheme would be a step forward, but would still differentiate between those who suffer a heart attack in the local hospital and those who suffer one at home.
We need a universal health care system and societal support that ensures all the injured are cared for, have a decent income and a shot at a decent life — irrespective of how their injuries are caused.
Doubling the disability pension and putting serious resources into support services for the ill would go a long way to solving the "indemnity crisis", as well as the "public liability crisis".
The way forward for Australian health care is through a well-funded, universal system.
From Green Left Weekly, July 24, 2002.
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