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Splintered healthcare, divided responsibilities

By John Dwyer - posted Thursday, 4 October 2007

Treatment plans for our ailing health system proposed by Labor are welcomed while the Government continues to propose division rather than integration of health services.

The imperatives

Before the last Federal election Australians consistently told pollsters that the state of our health care systems was their major domestic concern. None of the major structural reforms required to improve services and so ease those concerns have been forthcoming. The wretched jurisdictional inefficiencies associated with the current division of state and federal responsibilities, hinder reform and deny Australians the seamless focused care they need.

Without spending any additional dollars reforms could provide us with a system that far better responds to contemporary needs. Surely, with a new Federal election looming, both Labor and the Coalition should be vigorously and loudly promoting policies they believe would convince us they can improve the health of the nation?


The increasingly urgent need for health system reform is driven by four realities. First, given the ageing of the population and technological advances we would all like to enjoy, even a wealthy country like Australia must have a health system that is cost effective. The jurisdictional inefficiencies associated with the splintering of responsibilities for health programs between our governments waste between $2 billion and $10 billion a year and markedly reduce the quality of care available.

Second, and surely for most of us unacceptably, our “system” is increasingly unfair with personal financial resources rather than need determining the availability of high quality services in a timely manner.

Third, unlike so many other western countries, we have failed to respond to a mass of evidence which proves that the “win win” for health systems and their consumers is an adequately resourced new model for delivering primary care, traditionally the domain of general practitioners. In this new model a major emphasis is placed on prevention strategies and the early diagnosis and treatment of potentially chronic diseases.

The service, know widely as “Integrated Primary Care”, is delivered by primary care teams consisting of a full range of health professionals and frees up doctors to do what only doctors can do. This includes caring for sicker patients in a community setting who are currently sent to hospital. Such an approach can ease suffering, save us money and reduce the demand for hospital services.

In insisting that all is well with our primary care system as bulk billing rates are currently high, the Prime Minister fails to recognise that the quality (outcomes) associated with a visit to a doctor is what really counts. Socio-economically deprived Australians who must be bulk billed often experience inefficient very short consultations and unsatisfactory outcomes.

Finally we have a severe work force shortage that has been neglected for far too long. Health professionals and informed consumers have recognised for some time that in many hospitals there is too often a mismatch between the skills available and patient’s needs: a recipe for “misadventure”.


The Government’s approach

We know we can expect little in the way of structural reform from the Howard Government. Mr Tony Abbott has said on many occasions that he does not see the need to consider “reform” in his area of responsibility. High “bulk billing” rates are his measure for successful primary care from our GPs rather than the quality of the encounters with our doctors. Mr Abbott is however a consistent critic of the way states manage their hospitals, which are burdened with ever increasing demands that all too often is a product of unsatisfactory community care, largely the responsibility of his portfolio!

How ironic that just as Tasmania decides on a long overdue and sensible master plan for its hospitals, developed after extensive community and professional consultation, the Government stepped in and diminished the plan by taking over the Mersey hospital because its role was to change? Those changes were essential. Acute services could no longer be offered safely as the necessary workforce was not available.

The community must understand that all hospitals cannot provide a full range of services. Their ability to offer services of quality and safety must be the major factors determining role delineation. The distressing level of misadventure in our hospitals is most often related to a mismatch between patient needs and the available skills. It is essential, therefore, that hospital services be networked.

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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".

Other articles by this Author

All articles by John Dwyer

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