Welcome to the Doctors Reform Society of Australia

The Doctors Reform Society (DRS) is an organisation of doctors and medical students promoting measures to improve health for all, in a socially just and equitable way. The Society was formed in 1973 to support a proposal for a publicly-funded universal health insurance system.  Medibank (now Medicare) was successfully created despite opposition from the Australian Medical Association.

All members’ views are valued, open debate on all health issues is encouraged both within and outside the organisation, and consensus decision making is the norm.  The DRS functions as a medico-political think tank, a lobby group and a public resource centre.

50 years Anniversary Doctors Reform Society Conference and AGM.

NSW Nurses and Midwives Association Building
50 O’Dea Ave Waterloo NSW

Face to face and zoom.

Saturday 9th November 9.30 am – 5.00 pm
AGM in after lunch session
Zoom attendance will be available.

Please email drs@drs.org.au for zoom link (available from 1 November)
The zoom link will be circulated to DRS mailing list.

If you are attending the conference in person, please advise us at drs@drs.org.au
Further program information to follow closer to the event.

There will be a Conference dinner held at a location in Surry Hills on the evening of November 9.

The location is close to Central Railway Station and will be advised at the AGM.
It will be in proximity to The Friendly Society Hall where our first meeting was held.

Please let us know if you will be attending for catering numbers.

Any queries to drs@drs.org.au

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Join the DRS

Membership of the Doctors’ Reform Society is open to all medical practitioners and medical students who believe that everyone, regardless of their social or economic status, should have access to high quality healthcare.

Click here to find out more about membership
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Report on National Conference October 2019, Brisbane

 

We started the day with a talk from Dr Beau Frigault from Doctors for the Environment, who gave an overview of the disaster we are heading for but then concentrated on the significant contribution of the health care system particularly hospitals, makes to greenhouse gas emissions. He then outlined (in between torrential Brisbane rain on the tin roof) a wide variety of measures that hospitals are implementing to address this, both in the design of new hospitals and in retrofitting older hospitals but also indicated relatively simple changes such as using different anaesthetic gases eg servoflurane instead of desflurane which can also help significantly. The emphasis however was that for change to happen in established hospitals a commitment to fund a dedicated person to the task is required.

We then had a fascinating and eclectic talk from Dr Andrew Gunn about how he manages to provide health care to about 500 patients who are mainly living in hostels, are all significantly disadvantaged, with a major contribution from mental illness. He referred also to two other examples of doctors who have set up systems to deal with the most disadvantaged and provide them with the health care they deserve and would seldom receive from standard GP practices, the first in Perth where the emphasis is on addressing homelessness as a major contributing cause of disadvantage, the second in Melbourne where, with the benefit of Community Health Centres carrying on from their beginnings as a Whitlam initiative, provide comprehensive care across many inner city Melbourne suburbs.

The afternoon started with a talk from Ben Cohn from the Australian Digital Health Agency, giving us an update on how it is progressing. The best we could establish from him was that the ADHA was continuing to play with the data they had, but had not really made much progress in terms of meaningful and useful engagement with either health care providers or patients to make My Health Record a particularly useful product. Nor was there any indication that the ADHA had understood the concerns regarding patient control of the information which we and others have raised previously.

The day ended with our AGM and reappointment of the previous committee unchanged, and we then proceeded to an excellent vegan meal nearby.

Next year we plan to meet in Western Australia

 

Read more here

Media Releases

21st May 2024

Health Care: A Disappointing Budget

By: Dr Peter Davoren

“Why has health care been almost ignored in this year’s budget”, asks Dr Peter Davoren, Secretary, Doctors Reform Society. In January last year Health Minister Butler said, “Frankly I think our general practice right now is in the worst shape it has been in the 40-year history of Medicare,” His Strengthening Medicare Taskforce made many recommendations and the Minister said at the time that ‘a comprehensive revamp’ was required, including addressing ‘structural issues’. Read more

Articles

12th Apr 2024

Aged Care Funding: On the Road to Entrenched Inequity

Pearls and Irritations
By: Dr Tim Woodruff

UK Health Minister Aneurin Bevan introduced the National Health Service (NHS) pointing out that “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community.

Advancing age brings with it infirmity and a much higher likelihood of ill health. People do not choose to become old and infirm.  

Whilst conservatives despise the sentiments expressed by Bevan, particularly the concept of sharing by the community, liberals do agree, but with very variable degrees of commitment.

Aged Care is a major concern. Recent discussion following the Royal Commission has been about what services should be provided, how to regulate quality, how to get appropriate workforce, and how to fund what is needed.

The main funding recommendations from the recently released Aged Care Taskforce report are means tested co-payments and a safety net to supplement ongoing government funding.

Examples of co-payments and safety nets.

The public hospital system provides first class hospital care to all and if it’s an emergency the care will be timely. If not, unacceptable wait times prevail. Public hospital care becomes a safety net. Those with means bypass the wait times and use the government subsidised private hospital system. Those without suffer.

Primary health care through GPs or other health providers is in theory accessible to all, except for the geographical inequities which have the greatest negative impacts on low-income earners in rural and remote locations. But even in the cities inequities abound.  Co-payments make a mockery of affordable access to care. The recently introduced increased rebates for pensioners, health care card holders (HCCH), and children does not mean they will be bulk-billed. It also leaves people just above the cut-off for an HCCH facing an average $40 co-payment per GP visit.

Visits to specialist physicians and surgeons regularly incur a $100 co-payment which sends many patients away and onto the years long waiting list at a public hospital.

A rebate subsidised psychology visit regularly costs $100 co-payment, well outside the affordability of an unemployed patient on sickness benefits, and a challenge to a low wage earner.

The above relate to voluntary co-payments applied by providers. Then there are government-imposed co-payments with safety nets. Prescription drugs are subject to co-payments of $7.30 per prescription for Pensioners and HCCHs and $30 per prescription for others. Despite the existence of a Safety Net, an estimated half a million people delayed or did not fill a prescription in 2021 according the Australian Bureau of Statistics Patient Experience Survey.

No Australian Government in recent history has delivered equity through a co-payment system. Equity in health has been defined by Starfield as ‘the absence of systematic and potentially remediable differences in one or more aspects of health across populations or population groups defined socially, economically, demographically, or geographically.’ The definition could be easily applied to Aged Care and education.

Conservatives are not interested in equity. Successive Labor Governments however, have also shown a lack of commitment. Many Labor politicians would describe themselves as social liberals. Perhaps this lack relates to the reality that equity is not at the heart of any form of liberalism. It is an optional extra, talked about by social liberals as an aspiration, but falling second to the priorities of the individual.

Problems with co-payments, fee-for-service.

Co-payments limit access to items of care. The size of the co-payment is at the whim of the provider or the Government. A Labor Government, led by Julia Gillard from the left faction, introduced a GP co-payment for economic reasons, knowing such payments would be inequitable. The vagaries of economic and political factors determine how much and who will pay.

To determine a co-payment, one needs an item of care. There are some situations where itemised care with appropriate caveats can help to determine appropriate payments. Itemised care, especially in primary health care and Aged Care, leads to a siloed approach, which is completely at odds with the complex care needs in Aged Care and chronic disease. It limits teamwork, including teamwork which involves the consumer/patient interaction with the provider team.

Problems with safety nets

Look at a net. It has holes in it. It sags. It has edges. One could regard the Aged Pension as a safety net. Imagine being a 70-year-old widow whose only work throughout life was low paid, and whose rental cost is 50% of her pension. She has rental assistance, another safety net. She lives below the poverty line.

The Safety Net for prescription drugs helps. But a 20-year-old couch surfer, living with a mental illness, doesn’t register for the net. Even if he did, it doesn’t cut in until he’s spent a certain amount. How does he afford his drugs until then?

The vagaries of economics and politics determine the level and quality of safety nets.

Conclusion

Firstly, when the more powerful and articulate in a community are not subject to the inadequate service provisions of health, Aged Care, and education because they buy their way past such inadequacies, their advocacy for improvements in the system for all is weakened. The safety net sags lower.

Secondly, to adapt Aneurin Bevan’s 1948 quote regarding introducing the NHS: “No society can legitimately call itself civilized if an elderly and infirm person is denied Aged Care because of lack of means”

Thirdly, inequity is entrenched with every introduction of a user pays, means tested co-payment system with safety nets. If Labor does not want inequity, the alternative is funding through an adequate progressive revised tax system.