Published Letters

I agree with Ross Gittins (Age 1/5) that we provide quality health care as well or better than most countries but with several important caveats. Firstly, that care is not available in a timely manner to many. Access is determined by postcode, whether it is financial or geographic or cultural disadvantage. We are down the list of OECD countries when it comes to timely affordable access.

Secondly, it is optimistic to call our health care a health system. It consists of multiple silos which are often a nightmare for patients and carers to negotiate. That may be the same elsewhere, but relates to our federated system.

Thirdly, the main theme of the argument is improved productivity due to technological advances for specific ailments. That is just one part of health care. Countries with high quality primary health care (not the fancy new technology), have improved health across the socioeconomic spectrum.

We hope that the evolving approach of Labor to that issue will continue apace.

We ranked No. 1 out of ten for our health care system according to the US based Commonwealth Fund (This healthy nation’s fit for a fall 2/10). The ranking was based on combining 5 different measures. On access to health care we ranked ninth, just above the USA. Somehow, despite that appalling ranking, we ranked No,1 on equity. How could that be? The measure of equity this think tank uses is obviously grossly inadequate. We are clearly not number one, as the many patients struggling to access care, will attest.

In addition, we rated No.1 on health outcomes, another of the five measures. Health outcomes are hugely determined by the social determinants of health, the conditions in which we work, live, and play. These are not part of the health system.

Let’s not kid ourselves. Our health system needs reform.

One hundred and twelve deaths from Covid in a week in Victoria and not a squeak from our politicians (Sunday Age 18/6). No press conference to encourage mask wearing especially in indoor crowded places and public transport, to once again explain that if it’s 6 months since your last vaccination or infection you should have another vaccination, and no encouragement to have HEPA filters in indoor spaces.
The lowest death rate for Victoria in the last 12 months was about 20 per week in late January. Up to 10% of those infected get long Covid even with mild disease. Most deaths occur in the elderly. If the preventive measures were repeatedly encouraged the death rate might be halved. These preventable deaths are the responsibility of our politicians who refuse to lead. Their policy is ageist. Old people don’t matter. Their behaviour is morally indefensible.

A radical idea to improve access to health care across the nation is being discussed. It proposes that doctors would be unable to access Medicare if they set up practice in an area of oversupply, such as rich suburbs. This would then encourage doctors to work in areas of undersupply in order to access Medicare benefits. It also proposed that if doctors wanted to get Medicare rebates they might need to bulk bill patients. It comes with a requirement that rebates be determined by an independent Pricing Tribunal.
Whilst radical, it is based on a very mainstream principle that health care should be available to all irrespective of income or geography.

The Australian Medical Association came out strongly claiming doctors would be forced to bulk bill. Doctors could still have a purely private practice wherever they want but might not get Medicare funding. That’s how it is for many in the USA and some in the UK and for patients in Australia who don’t’ have a Medicare card.

What a progressive idea.

Bulk billing rates are falling. Patients can’t get care when they need it. GPs are deciding whether to give up bulk billing completely. The Federal Government has a long-term plan which is good. It won’t help patients for years. Help for our most disadvantaged patients is needed now.

GPs are paid a $7 incentive if they bulk bill pensioners and health care card holders, some of the most disadvantaged in our community.

Today Minister Butler could increase that payment to immediately help those patients and reduce the likelihood of GPs giving up bulk billing.

Today he could set in place an adjustment to a small special payment GPs get called the Practice Incentive Payment. Its value currently depends upon age and gender. He could add socio-economic status to that adjustment.

Both steps are easy and directed at our most vulnerable and disadvantaged patients. Both would encourage GPs to stay working with such patients in areas across Australia where patients simply cannot afford $40-$100 co-payments.

Please Minister, act now to address the crisis

As an arthritis specialist, I see patients who require major treatment for decades. I’m not expected to limit my visits to 10 or 20. Under the Better Access scheme, patients are limited to 10 psychology sessions for their condition. Mental health treatments should be available for as long as they are needed.

The problems arise from several factors. Firstly, it has been forgotten that the scheme introduced in 2005 was aimed at mild to moderate conditions and therefore one could expect only a limited number of treatments would be required. Understandably, without alternatives, it has been used for complex conditions. Secondly, it was funded fee-for-service (rebate) with an option for the psychologist to charge a co-payment. That method of funding is fundamentally flawed.

Public hospitals and Aboriginal-controlled health services have salaried health professionals. No co-payments and everyone is seen, and time is limited only by the inadequate funding of governments, not the value of a patient’s credit card.

The suggestion that multidisciplinary care is not appropriate for complex mental health conditions would seem to suggest that inadequate housing, income, domestic violence and racism have no effect on outcomes.

Our COVID-19 vaccination roll out is way behind. When will the Federal Government tell us why? Why are mass vaccination centres only now being planned for NSW? Why must one book online? Why are private companies being paid to organise the roll out? The Australian Defence Force members lives depend on good logistics so why not use them for free?
Why does Health Minister Hunt say we are ‘on track when’ targets have not been reached? What does he mean? Are we on track for more cases and deaths because our targets haven’t been met? Are we on track for further business failures and further specific sector unemployment because we are behind on the roll out?
Can the Prime Minister tell us why we are behind, what are the specific hold ups in the roll out, what is his team doing to fix them, and what are the new targets?

Jobs Minister Kelly O’Dwyer’s assertion that ‘there is nothing more important and fundamental to a person’s wellbeing than a job’ (Age 20/3) will be news to many of my non working patients. This is especially so for the ones who can’t quite pass the very tight test for a disability support pension but who at the age of 60 with no computer literacy, are definitely unemployable because of illness.

The news that they can now go digital will not help. They will be left to wonder when the next computer generated robo-letter falsely accusing them of getting too much welfare will arrive.

I hope the assertion that ‘we cannot consign people to a life of welfare’ does not mean that it plans to eliminate disability support pensions. We have the tightest welfare rules in any developed nation. We don’t want to make things even harder.

 Tim Woodruff

President

Doctors Reform Society