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Federating health care would mend our health system

By John Dwyer - posted Monday, 10 May 2004

The recent meeting of Australia’s Health Ministers appeared an affable affair. Most of the media focussed on their laudable attempts to increase the number of human organs available for transplantation. There seemed no contentious issues on the agenda and a visitor to our shores might have concluded that our health care system needed no more than some fine-tuning.

Of course the reality is very different.

When our health ministers went to bed that night, they were presiding over a health system that is increasingly, and to most Australians, disturbingly dysfunctional.


It is also increasingly less fair.

Recent research clearly demonstrates that health outcomes for our citizens are linked to socio-economic circumstances rather than need. People living in poorer suburbs or many rural areas can expect to die prematurely from a preventable disease respectively five and eight times more frequently than their richer cousins in wealthy suburbs.

The situation is of course, much worse still for our indigenous Australians.

The College of General Practitioners has recently learnt that 21 per cent of poorer Australians don’t have their prescriptions filled, while 17 per cent decline necessary investigations because of personal cost.

Recent changes to Medicare will, at best, halt the pace of the decline in bulk billing rates but do nothing to help Australians in most need of quality time with their doctors.

Contemporary health demands require primary care physicians to be able to do more to prevent illness and care for sicker patients in their home or community rather than hospital but these are unattainable goals in our current system.


The health care system we need at the start of the 21st Century should be patient focussed (as opposed to provider focussed) and feature the integration of all the various elements that must work together to supply our health care system. Improvements in quality, safety and cost effectiveness are rewards for so doing. In our country it is proving to be impossible to provide such desirable and professionally achievable goals because of the wretched jurisdictional inefficiencies inherent in the fragmentation of health care responsibilities among our governments.

To save money, hospitals (the responsibility of state governments) discharge patients with one or two days worth of medication so they must race to their doctor for a further prescription (a Commonwealth Government responsibility). So it’s tough if you can’t get an appointment with your GP for a month!

The Commonwealth Government’s ability to provide health care directly is limited by the Constitution. It helps Australians by purchasing health from independent providers (doctors, nursing home providers, drug companies etc) and provides support for the hospital system delivered by state governments. This system has now reached a point where it is unworkable. At this crisis point it is surely the responsibility of the health ministers to accept informed advice on how to rescue us from a mess, so colourfully and accurately described by Tony Abbott as a “dog’s breakfast”, and one that has too often been placed in the “too hard basket”.

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About the Author

Professor John Dwyer is Founder of the Australian Healthcare Reform Alliance and Emeritus Professor of Medicine at the University of NSW. He is co-founder of the "Friends of Science in Medicine".

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Department of Health and Ageing
Faculty of Medicine, University of NSW
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