President Reagan speaks about Socialized medicine.

[luckytxn 2,265]

Under-resourcing in Australian public hospitals has resulted in compromised care, with delayed diagnosis in surgery, inadequate treatment and psychological and social disruption related to often indiscriminate cancellation of surgery lists and patients. Public hospitals have been an important part of the Australian healthcare system since Federation and, in more recent years since the introduction of universal health insurance have been involved in both preventative health initiatives, community care, delivery of hospital acute services, education and training of health professionals and research. All of these activities represent fundamental ingredients of a healthy and developing system and must be equally supported if significant distortions are not to occur or service is to be compromised.

The Problem

The difficulty facing the Western world, however, is one of an ageing population linked to the increasing number of inhabitants within, certainly, Australia. This increasing age of the population carries with it substantial changes in not only the nature of healthcare that needs to be provided but also the incidence with which healthcare is being sought 1. In order to meet this challenge, appropriate training needs to be in place and, in the case of surgery, an adequate exposure to clinical conditions, operative time and an appropriate mix of cases needs to be made available. This, unfortunately, has not been possible in many public hospital environments due to the need to manage only the most urgent cases with the more elective patients often failing ever to receive surgery. Strategies to deal with this are being developed and have largely involved utilising the private healthcare system, which is responsible for in excess of 55% of the surgical procedures performed within Australia at this time. In order to manage the burgeoning demand for public hospital services, rationing has been occurring within the sector. Unfortunately politicians are reluctant to inform the public that such rationing is necessary and temporary freezes, adjustments to waiting lists and restriction of surgical time have been the primitive and blunt instruments used to control demand. This has led to inefficient use of substantial capital resources and a significant increase in bureaucratic positions aimed to justify the diminishing return from the public hospital enterprise. This has substantial clinical implications for the patients being treated within such a system. Because of delays to be seen in clinics and assessed, often diagnoses are made at a later date than is desirable. With the demand on investigative resources such as colonoscopies, endoscopies and imaging, the time to achieve diagnosis is further drawn out. The trauma, both psychological and in the ensuing surgical intervention, is increased for the patient and the surgeon and the system is forced to manage more advanced disease than it would otherwise wish. This situation needs a major refocus of the enterprise so that it becomes disease and patient focussed rather than attempting to maintain an outmoded public service structure in a highly dynamic and changing environment.

Much of the problem stems from an increasing disengagement of clinicians from the management decisions. Clinicians are used as service deliverers and their input into the structure of the service, the management of it and the appropriate development of new technological developments are largely ignored. In Australia, this difficulty is further exacerbated by the almost unworkable situation of the funding model. Australian taxpayers’ money is collected by the Federal Government, however the Federal Government passes the required funds for the public hospitals on to the State Governments. How these funds are expended is open to manipulation and abuse, leading to non-uniform services across the country 2. To further compound the confusion, attendances to general practitioners are, in part, funded by the Federal Government through the Medicare system. This creates at a local level a tendency to cost shift from the States to the Commonwealth wherever possible, with the Commonwealth constantly trying to limit this activity. The time, effort and expense in managing this cost shifting exercise could be far better deployed into the provision of healthcare rather than more bureaucratic positions.

It is a source of constant bewilderment that within the health system surgeons are mainly complaining about their inability to deliver the service they require. Most of the surgical community would wish to do more operating, see more patients and teach more doctors if the opportunity was made available to them. Instead of applauding this energy and enthusiasm, the efforts of Government and local jurisdictions seem preoccupied with frustrating, discouraging and alienating the surgeons who could, indeed, be part of one of the most dynamic health systems in the world.

Because Australia has a dual public and private health system, with over 50% of the population being treated surgically within a private environment, the option for many practitioners is to disengage from the public health system and focus more on their private practice. This is not only motivated by financial considerations but also the autonomy and ability to control standards, care patterns and ensure that patients are treated in a timely fashion.

Solution

The healthcare system is a complicated structure and simple solutions are difficult to deliver. The most productive way forward would be to encourage a culture of teaching, research and service which are equally well supported. This brings with it many benefits in not only providing an environment which is attractive to surgeons and other clinicians in which to work but also enables the profession to be at the forefront of new developments in an environment of evidence based assessment and a culture of critical appraisal. Clinicians need to be encouraged to take leadership roles by providing protected time and funded opportunities to participate in leading their clinical colleagues in the current environment of rapid change and new technologies.

Gaining clinician input into such a bureaucracy is complex and requires a flexible approach by existing health authorities. Scheduling important meetings in the middle of operating lists is unlikely to gain much clinical input and there needs to be an increased appreciation that clinicians need well focussed outcome-directed interactions which are not merely “talk fests” designed to appear to have consulted without actually acting on the advice. Clinicians must also accept that the resources for the provision of healthcare are limited and if the current trend in consumption of gross national product in healthcare continues an unsustainable situation will develop 2. There is good evidence that countries that spend a high percentage of their gross national product on healthcare fail to deliver a better standard of care when assessed in terms of infant mortality, length of life and satisfaction with the healthcare system 1,3. Surgeons have, however, been major players in developing innovative approaches to healthcare. Day of surgery admissions are now in excess of 80% in many centres, day surgery has become an accepted part of the healthcare system and participation in audits of quality, such as the mortality audit administered by the Royal Australasian College of Surgeons and funded by State Governments, is a positive illustration of the type of collaboration that can be developed between clinicians and Government 4. New models for the provision of emergency cover across the health system, service to rural areas, particularly those remotely located, and greater integration between the country, city and academic organisations needs to occur. Unfortunately, within the healthcare sector manpower, predictions have been notoriously inaccurate 5. Government has, in the past, restricted the number of medical school places in the mistaken belief that the medical workforce would continue to be made up of predominantly male doctors prepared to work in excess of 80 hours a week. This has not occurred. With the feminisation of the medical workforce and a more life-style orientated working hours for many of the more recently graduated medical staff, the response has been to dramatically increase the number of medical school places with almost no regard to how these individuals will be trained, both academically and in an appropriate clinical environment 6. These types of half-thought-through knee jerk reactions have typified much of the healthcare planning within Australia in recent years. Ways to rejuvenate, in particular, academic surgery, use the private as well as the public infrastructure more cleverly to deliver teaching, look at training through achievement of competencies rather than time, all need rapid evaluation and implementation if these new medical graduates are to have the type of training that their teachers have enjoyed 7. However, the solution will need to go further than just training more doctors. There needs to be an overhaul of the way in which, particularly in the public sector, healthcare is delivered. A greater use of focussed and highly trained physician assistants, who have a range of academic backgrounds and who have appropriate delegated activities from their surgical leaders, will be one way in which not only protocols can be more closely adhered to but also skill levels can be maintained and more focussed teaching can be delivered by engineering jobs where training for doctors is the principal role and delivery of service is moved to such individuals as physician assistants.

Conclusion

Within the Australian healthcare system, adequate funding does exist for a high quality healthcare. What is required is more focus on the patient and less on the bureaucratic infrastructures attempting to justify the inefficiencies and waste within the system. Surgeons, in particular, must return to meaningful discussion and debate with Government as to how this can be achieved but Government, for its part, must take a long-term view of the healthcare of the nation and become less pre-occupied with the shortterm electoral imperatives which have largely dominated discussions in recent years. There is a recognition finally within both State and Federal Government that the current situation cannot continue. The solutions, however, seem to be elusive and will require focussed and unified approaches from clinicians, management and Government if we are not to see more money being poured into a system that has forgotten the patient as the central figure.

[Usui Takumi 1,562]

Under-resourcing in Australian public hospitals has resulted in compromised care, with delayed diagnosis in surgery, inadequate treatment and psychological and social disruption related to often indiscriminate cancellation of surgery lists and patients. Public hospitals have been an important part of the Australian healthcare system since Federation and, in more recent years since the introduction of universal health insurance have been involved in both preventative health initiatives, community care, delivery of hospital acute services, education and training of health professionals and research. All of these activities represent fundamental ingredients of a healthy and developing system and must be equally supported if significant distortions are not to occur or service is to be compromised.

The Problem

The difficulty facing the Western world, however, is one of an ageing population linked to the increasing number of inhabitants within, certainly, Australia. This increasing age of the population carries with it substantial changes in not only the nature of healthcare that needs to be provided but also the incidence with which healthcare is being sought 1. In order to meet this challenge, appropriate training needs to be in place and, in the case of surgery, an adequate exposure to clinical conditions, operative time and an appropriate mix of cases needs to be made available. This, unfortunately, has not been possible in many public hospital environments due to the need to manage only the most urgent cases with the more elective patients often failing ever to receive surgery. Strategies to deal with this are being developed and have largely involved utilising the private healthcare system, which is responsible for in excess of 55% of the surgical procedures performed within Australia at this time. In order to manage the burgeoning demand for public hospital services, rationing has been occurring within the sector. Unfortunately politicians are reluctant to inform the public that such rationing is necessary and temporary freezes, adjustments to waiting lists and restriction of surgical time have been the primitive and blunt instruments used to control demand. This has led to inefficient use of substantial capital resources and a significant increase in bureaucratic positions aimed to justify the diminishing return from the public hospital enterprise. This has substantial clinical implications for the patients being treated within such a system. Because of delays to be seen in clinics and assessed, often diagnoses are made at a later date than is desirable. With the demand on investigative resources such as colonoscopies, endoscopies and imaging, the time to achieve diagnosis is further drawn out. The trauma, both psychological and in the ensuing surgical intervention, is increased for the patient and the surgeon and the system is forced to manage more advanced disease than it would otherwise wish. This situation needs a major refocus of the enterprise so that it becomes disease and patient focussed rather than attempting to maintain an outmoded public service structure in a highly dynamic and changing environment.

Much of the problem stems from an increasing disengagement of clinicians from the management decisions. Clinicians are used as service deliverers and their input into the structure of the service, the management of it and the appropriate development of new technological developments are largely ignored. In Australia, this difficulty is further exacerbated by the almost unworkable situation of the funding model. Australian taxpayers’ money is collected by the Federal Government, however the Federal Government passes the required funds for the public hospitals on to the State Governments. How these funds are expended is open to manipulation and abuse, leading to non-uniform services across the country 2. To further compound the confusion, attendances to general practitioners are, in part, funded by the Federal Government through the Medicare system. This creates at a local level a tendency to cost shift from the States to the Commonwealth wherever possible, with the Commonwealth constantly trying to limit this activity. The time, effort and expense in managing this cost shifting exercise could be far better deployed into the provision of healthcare rather than more bureaucratic positions.

It is a source of constant bewilderment that within the health system surgeons are mainly complaining about their inability to deliver the service they require. Most of the surgical community would wish to do more operating, see more patients and teach more doctors if the opportunity was made available to them. Instead of applauding this energy and enthusiasm, the efforts of Government and local jurisdictions seem preoccupied with frustrating, discouraging and alienating the surgeons who could, indeed, be part of one of the most dynamic health systems in the world.

Because Australia has a dual public and private health system, with over 50% of the population being treated surgically within a private environment, the option for many practitioners is to disengage from the public health system and focus more on their private practice. This is not only motivated by financial considerations but also the autonomy and ability to control standards, care patterns and ensure that patients are treated in a timely fashion.

Solution

The healthcare system is a complicated structure and simple solutions are difficult to deliver. The most productive way forward would be to encourage a culture of teaching, research and service which are equally well supported. This brings with it many benefits in not only providing an environment which is attractive to surgeons and other clinicians in which to work but also enables the profession to be at the forefront of new developments in an environment of evidence based assessment and a culture of critical appraisal. Clinicians need to be encouraged to take leadership roles by providing protected time and funded opportunities to participate in leading their clinical colleagues in the current environment of rapid change and new technologies.

Gaining clinician input into such a bureaucracy is complex and requires a flexible approach by existing health authorities. Scheduling important meetings in the middle of operating lists is unlikely to gain much clinical input and there needs to be an increased appreciation that clinicians need well focussed outcome-directed interactions which are not merely “talk fests” designed to appear to have consulted without actually acting on the advice. Clinicians must also accept that the resources for the provision of healthcare are limited and if the current trend in consumption of gross national product in healthcare continues an unsustainable situation will develop 2. There is good evidence that countries that spend a high percentage of their gross national product on healthcare fail to deliver a better standard of care when assessed in terms of infant mortality, length of life and satisfaction with the healthcare system 1,3. Surgeons have, however, been major players in developing innovative approaches to healthcare. Day of surgery admissions are now in excess of 80% in many centres, day surgery has become an accepted part of the healthcare system and participation in audits of quality, such as the mortality audit administered by the Royal Australasian College of Surgeons and funded by State Governments, is a positive illustration of the type of collaboration that can be developed between clinicians and Government 4. New models for the provision of emergency cover across the health system, service to rural areas, particularly those remotely located, and greater integration between the country, city and academic organisations needs to occur. Unfortunately, within the healthcare sector manpower, predictions have been notoriously inaccurate 5. Government has, in the past, restricted the number of medical school places in the mistaken belief that the medical workforce would continue to be made up of predominantly male doctors prepared to work in excess of 80 hours a week. This has not occurred. With the feminisation of the medical workforce and a more life-style orientated working hours for many of the more recently graduated medical staff, the response has been to dramatically increase the number of medical school places with almost no regard to how these individuals will be trained, both academically and in an appropriate clinical environment 6. These types of half-thought-through knee jerk reactions have typified much of the healthcare planning within Australia in recent years. Ways to rejuvenate, in particular, academic surgery, use the private as well as the public infrastructure more cleverly to deliver teaching, look at training through achievement of competencies rather than time, all need rapid evaluation and implementation if these new medical graduates are to have the type of training that their teachers have enjoyed 7. However, the solution will need to go further than just training more doctors. There needs to be an overhaul of the way in which, particularly in the public sector, healthcare is delivered. A greater use of focussed and highly trained physician assistants, who have a range of academic backgrounds and who have appropriate delegated activities from their surgical leaders, will be one way in which not only protocols can be more closely adhered to but also skill levels can be maintained and more focussed teaching can be delivered by engineering jobs where training for doctors is the principal role and delivery of service is moved to such individuals as physician assistants.

Conclusion

Within the Australian healthcare system, adequate funding does exist for a high quality healthcare. What is required is more focus on the patient and less on the bureaucratic infrastructures attempting to justify the inefficiencies and waste within the system. Surgeons, in particular, must return to meaningful discussion and debate with Government as to how this can be achieved but Government, for its part, must take a long-term view of the healthcare of the nation and become less pre-occupied with the shortterm electoral imperatives which have largely dominated discussions in recent years. There is a recognition finally within both State and Federal Government that the current situation cannot continue. The solutions, however, seem to be elusive and will require focussed and unified approaches from clinicians, management and Government if we are not to see more money being poured into a system that has forgotten the patient as the central figure.

Lol now he's not even bothering to put sources......

[Heracles 417]

Australia paramedic hired as doctor in 'failing health system'

ABC Regional News

The ambulance union is outraged that a paramedic had to be hired to work at the Kyneton hospital at the weekend because there were not enough doctors.

A Government spokeswoman says paramedics are not being asked to perform duties other than normal practice and a doctor will always be available in an emergency.

A town of 4,900 people. Naturally, a private hospital network here would cover such a small town.

I'm enjoying these reads bud.

[Heracles 417]

The Problem

The difficulty facing the Western world, however, is one of an ageing population linked to the increasing number of inhabitants within, certainly, Australia. This increasing age of the population carries with it substantial changes in not only the nature of healthcare that needs to be provided but also the incidence with which healthcare is being sought

Lol now he's not even bothering to put sources......

Who knew googling articles was the basis of a discussion.

While blindly copying and pasting, he must have missed the section I cut it down to.

That article actually illustrate that even in the United States, the problem is not Medicare but the aging population. Thanks TX.

Edited August 14, 2009 by haza

[Usui Takumi 1,562]

Can I start using the spam button yet??

[luckytxn 2,265]

Great quality y'all have there. Long wait times and even rationing of health care. Great job Australia.

[Pinocchio Liberal 268]

I got freinds in perth and they say it sucks.

[Ban Hammer 14,569]

the military in the US is voluntary ... it also requires more from a person than simply signing up to receive free health care.

You're missing my point. If the government works for the military, why can it not work (be used) to run any other sector? And we know repubs eat and sleep military.

Therefore, if the government's buying power is good in one sector, such as the military, why not apply this same strategy elsewhere? to something as crucial as health care. We already use it in education.

so how many years do you have under the military health care system again?

[natty bumppo 297]

the military in the US is voluntary ... it also requires more from a person than simply signing up to receive free health care.

You're missing my point. If the government works for the military, why can it not work (be used) to run any other sector? And we know repubs eat and sleep military.

Therefore, if the government's buying power is good in one sector, such as the military, why not apply this same strategy elsewhere? to something as crucial as health care. We already use it in education.

so how many years do you have under the military health care system again?

he must be trying to untie his shoes so he can count .... to one ...

Edited August 15, 2009 by Natty Bumppo

[luckytxn 2,265]

the military in the US is voluntary ... it also requires more from a person than simply signing up to receive free health care.

You're missing my point. If the government works for the military, why can it not work (be used) to run any other sector? And we know repubs eat and sleep military.

Therefore, if the government's buying power is good in one sector, such as the military, why not apply this same strategy elsewhere? to something as crucial as health care. We already use it in education.

so how many years do you have under the military health care system again?

Don't hold your breath.

[rebeccajo 14]

luckytxn -

What do you think happens to mental health patients in the US?

Do you know?

Who pays for their care? How long do you think they wait in the ER? What does it take for them to be admitted to a facility? How long do you think they get to stay there? What happens to them when they are discharged?

[Trumplestiltskin 5,791]

luckytxn -

What do you think happens to mental health patients in the US?

Do you know?

Who pays for their care? How long do you think they wait in the ER? What does it take for them to be admitted to a facility? How long do you think they get to stay there? What happens to them when they are discharged?

I know what happens - they are living in cardboard boxes in Manhattan, Skid Row LA and most other urban downtowns.

Edited August 15, 2009 by Private Pike

[DIARD 1]

I have read since the beginning. But I will go over it one more time just for you.

Summary:

I believe you were inferring that because the state of our country at the moment, now was not the time for a NHC. Then it was stated that Britian started NHS after WWII when they were in a dire financial state. Lkytxn inferred that yea but the US forgave the debt to which was pointed out that actually Britian has repaid the debt in 2006. Natty then comes in with this long post about what was paid back and what wasn't and that he thinks that the loans from US paid for NHS. So I posted so what, we owe china billions and haven't paid them back (in reference to the WWI loans that Uk stopped paying on in 1934 stated by natty). Then you said I was a hater for stating facts. To which I responded it wasn't hating it is the truth. Also said who cares what the loans were used for at least they had a reason to be in debt. What reason to we have? (Certainly not NHC)

So you see it was in reference to what was posted by Natty. Perhaps you are having a hard time following along, maybe trip to the doctor to use that wonderful insurance of yours would be of some benefit?

The whole us paying off the debt had to do with Lkytxn pointing out that Rabjaco original statement left out some important details. Somebody came in and challenged Lkytxn's statement, Rabjaco and Empress I believe, Natty and Lkytxn continued to give them evidence to prove that the original statement was accurate. Which was a statement that had to do with the topic, at this time you made this comment -

If I am not mistaken, the US owes quite a bit more than this China at the moment and that debt didnt come about because of World War.

How was that on topic to what we were addressing?, it simply wasnt.

It wasn't addressed to you as I stated before (see bold section). It seems you have some trouble with your reading comprehension. What I summarized was what was said. You might have started that little aside with your inference that now was not the time to start a NHC in this economy, but I was addressing Natty's comment about the UK stopping payments on the debt and the end where he said something to effect of Can't we all agree the US loans helped start the NHS. Like I said, sigh, and will say again, so what. We, the USA, owe China billions of dollars that we did not get because of a WORLD WAR and we did what do with it??? Fund Bush's war? Pay for Cheney's assasination squads? Lined Halliburton's pockets? Stretch out Terri Shivo's last days?? At least the UK used it to rebuild their bombed out country and paid it back. So just so you can understand it I will repeat myself AGAIN. I was responding to Natty's comments NOT YOU. Jeez, it is amazing how many posters on here have trouble following along.

[DIARD 1]

I have read since the beginning. But I will go over it one more time just for you.

Summary:

I believe you were inferring that because the state of our country at the moment, now was not the time for a NHC. Then it was stated that Britian started NHS after WWII when they were in a dire financial state. Lkytxn inferred that yea but the US forgave the debt to which was pointed out that actually Britian has repaid the debt in 2006. Natty then comes in with this long post about what was paid back and what wasn't and that he thinks that the loans from US paid for NHS. So I posted so what, we owe china billions and haven't paid them back (in reference to the WWI loans that Uk stopped paying on in 1934 stated by natty). Then you said I was a hater for stating facts. To which I responded it wasn't hating it is the truth. Also said who cares what the loans were used for at least they had a reason to be in debt. What reason to we have? (Certainly not NHC)

So you see it was in reference to what was posted by Natty. Perhaps you are having a hard time following along, maybe trip to the doctor to use that wonderful insurance of yours would be of some benefit?

the long post part ... guilty

did I state the loan from the US paid for NHC? the UK used their money to build NHC. the US gave the UK heavily discounted material and permitted the remaining war debt to be paid over a long period of time. did the war material loan help the UK rebuild and achieve NHC by letting them keep their cash position from total failure ... maybe yes ... maybe no ... maybe yes and no. as stated before ... I don't know. (maybe someone here can shed some light on this topic).

"Can we agree the UK decided to rebuild and also institute NHC due to a generous loan/agreements with the US that gave them access to spendable funds? I don't know if this helped finance NHC or not ... I'll let others weigh in on this ."

Actually that is what you said Natty I bolded the parts at the end there but with quote you also: "Can't we agree the UK...instituted NHC due to a generous loan/agrements with the US." How else was a reader suppose to take that but at face value?? Not that they didn't rebuild and start the NHC with US money but that wasn't my point. My point was SO WHAT??? They did something positive and paid off the debt whereas the USA is in debt to China for what? And I don't think we made any progress paying that back yet. Now did any of this have anything to do with the OP? No But then neither did what I was responding to (that last part was for Looking up not for you natty)

[웃 910]

Confucian -

What do you think happens to mental health patients in the US?

They get treated.

Do you know?

Who pays for their care?

They do

How long do you think they wait in the ER?

Less than 6 hours

What does it take for them to be admitted to a facility?

Nothing. They can voluntarily enter a mental facility or involuntarily enter (unwillingly taken by police or family/friends)

How long do you think they get to stay there?

Patients admitted involuntarily (against their own will) stay until their psychiatrist gives them clearance. This can be anywhere from 3 days to (in rare cases) years.

Patients admitted voluntarily can walk out on the third day, no questions asked. They can stay longer if they want.

What happens to them when they are discharged?

They go home with their prescription medication and follow the doctors orders.