Issue 17 / 19 May 2014

WAS anyone else surprised by the flamboyance that accompanied the delivery of last Tuesday’s federal Budget?

I was pretty unpopular at home for forsaking our current family ritual of predicting whose chairs will turn on The Voice in favour of the Budget. Between the Treasurer and a few trolls on Twitter, I think I got better entertainment.

Then for an encore on Thursday (with no significant programming clashes) came the Opposition leader’s reply: a “spirited” and equally theatrical, colour-coordinated warning to the government that they would seek to block the projected reforms to health, welfare and education when they come before Parliament.

Of course, politics being politics, warnings often go unheeded. Our first InSight news story visits the Budget one more time, in relation to an initiative that attracted a lot of discussion and warnings long before it was revealed on Budget night — the Medicare copayment. It seems evidence provided over the past few months about the detrimental health impact and economic folly of copayments changed nothing in the Budget regarding Medicare, leaving health leaders, economists and policy experts a little disillusioned, but energised for a fight.

Writing early this year in the MJA, academics from the Nossal Institute for Global Health warned that there were uncertainties about the health effects of unconventional gas production and that Australia should proceed with caution.

A follow-up letter to the Journal, outlining an instance of groundwater contamination with heavy metals and uranium from a coal seam gas operation in north-western NSW, is the subject of our second news story.

With the recent suspension of gas exploration at the highly controversial Bentley site in northern NSW, and the mining company’s referral to the NSW Independent Commission Against Corruption for inadequate community consultation, emerges another salient warning — the need for informed public discussion about health harms and benefits before embarking on such projects.

Our third news story puts telehealth on notice, with a perspective article in the MJA pointing out that a lack of clinical and economic evidence is leading to slow and patchy implementation. Mobile technologies — cheap, efficient and almost universally available — may save the day but these too should be subject to careful evaluation.

A sobering warning for those of us who are part of the vaccinated generations emanates from a comment article this week. In a long career as an infectious disease physician, Emeritus Professor Clem Boughton saw severe cases of diptheria, polio, pertussis, congenital rubella, measles and other vaccine preventable diseases. He is now on a mission to ensure that we never forget why we immunise our children and to make sure future health professionals recognise a case when they see one, by preserving an archive of clinical photographs and recordings.

Not everyone gets the benefit of a warning. In her column, Jane McCredie reveals the growing phenomenon of surrogacy in India, wondering how the young women who agree to be involved can be fully informed of the many risks involved.

While the “entertainment” value of the Budget debate is likely to be turning chairs for some time to come, and as politicians churn out the classic ballads of class warfare and election speculation, it needs to be remembered that what happens next will impact on Australians’ future health.

During last Tuesday night’s fracas, a good friend who is a GP sent me a text which I added to the Twittersphere: “This co-payment won’t make GPs any less likely to do other than what’s best for patient care” — a grassroots perspective reflected in the comments of Professor Geoffrey Dobb, AMA vice-president, to InSight. Dobb reinforced the AMA’s position that its job was to help minimise the adverse impacts and unintended consequences of the federal Budget’s health measures, “particularly in terms of the impact on services for poorer people and children”.

With a few notable exceptions, doctors are not given to strutting their stuff on stage, but our medical leaders have made it abundantly clear that they will continue to strive for what is best for patients.

Politicians and policymakers, consider yourselves warned!

Dr Ruth Armstrong is the medical editor of MJA InSight. On Twitter @DrRuthInSight

8 thoughts on “Ruth Armstrong: You’ve been warned!

  1. DR. AHAD KHAN says:

    The Solution is to go back to the System which was prevalent before  Medibank mark 1 was introduced.

    The Govt should not undertake to protect the whole of the Population. Their responsibility is to protect the Under-priveleged in our Society. Let the ‘ Well-off ‘ ( the Govt. can demarcate a Cut-off point between the ‘ Well-off s ‘& the ‘ not-so-well-offs ‘. Let the Private Health Insurers cover the  Well-offs’  visits to the GP.

    Public Hospitals should provide Free Service to the ‘ Not-so-Well-offs ‘ & the ‘ Well-offs ‘ should seek Private Hospitals. This way, the the ‘ Well-offs’ do not put their burden on to the Public Hospitals & make it easier for the ‘ Not-so-well-offs ‘ – their Waiting Lists for Elective Surgery will almost vanish.

    Nothing wrong with a 2-tier Health Health System – as the Public Hospital Specialists are top class already & so, there will not be a Quality Differential.

    Dr. Ahad Khan 


  2. Department of Health Victoria Clinicians Health Channel says:

    Sounds like somebody who didn’t experience the pre Medicare days, of “charity ” medicine for the poor, if they could get somebody willing to provide it and were prepared to endure the humilation of asking.

    Quality differential argument is an important one. There is good evidence that once one adjusts properly for risk ( i.e. for the fact that private medicine skims all the high -profit, low risk patients) that for-profit medicine is associated with higher risk adjusted morbidity and mortality across most disciplines, the greatest differential being in Obstetrics ( Devereaux et al , CMAJ )

    The government is therefore pushing us in the direction of a system which will see more patients  managed in a system that has been shown to produce worse outcomes. ( but lotsa money for private insurers and hospital corporations – well represented among BCA’s backers ).  

    It is also going to push up the percentage of GDP spent on health care because of the perverse incentives inherent in the private system ( do more – get paid more ) . One only has to look at the USA to see where this will end ( 18% of GDP on healthcare and health statistics that are close to  developing world range ).

    It is sort of like shooting oneself in both feet – worse care, less prevention and more expensive

    The future lies in prevention and in a viable GP system, which would be gutted by the current proposals.

    The future is also dependent upon a public hospital system, to deal with thehard stuff ( saying this off a lifetime of cleaning up the messes created by  private medicine )







  3. DR. AHAD KHAN says:

    Andrew, you state – ” The future lies in prevention and in a viable GP system, which would be gutted by the current proposals.”  

    This is a look-good Statement only, unless you can explain how you would implement what you are stating.

  4. stephen p ballard says:

    Continuing the private health ins rebate…daft.  Paid parental leave. Outrageous…how is one baby worth 50K, another 12K.? No penalties for fossil fuel mining, despite compendious evidence to show that their community and environmental costs are greater than profits?

    No support for alternative fuels? And, if the so called potential fiscal disaster is a lie, how is an impending 0.6Trillion deficit, not disputed, acceptable.

    And, the Monty Pythonesque situations of billionaires slugging it out with the State over their rights to be richer yet!

    “Health” (strictly, mostly, illness management) and education have been dudded for decades.

    I’d be happy to see big medical payment reductions in favor of investment in Education.

    We do pay prodigious amounts for expensive and what are, from community standpoints, useless programs and treatments. And squillions on roads that benefit few, but encourage bad behaviour, and the environmental effects of increased private transport.

    In the final analysis, none of the Parties have said to the public…”this is all the dough we’ve got, so if you don’t want to pay taxes, what do we dump?.”

    If humans are in some way special,( which is not really supportable), then the Special need to look after the perceivedly less special.



    What is best for our country is best for our patients.  All Australians…and that includes doctors …need to know THERE IS NO FREE LUNCH.  The most expensive health system is a free system.  Let me say that again in case it does not sink in for some bleeding heart economists.  FREE IS THE MOST EXPENSIVE.  If you do not understand why that should be….open a shop and start giving away products for free.  “Business” will be booming…and you will go broke.

    But here is the sad part:  The average GP has the lowest self respect in the history of our noble profession. Even a hair dresser or a locksmith has the courage to ask for payment from their loyal customers. 

    By all means give your charity to those who need it…but why give charity to those who don’t ?

  6. Guy Hibbins says:

    The plain truth is that the population is getting older and the proportion of retirees is increasing and with these changes healthcare and pension expenditures are bound to rise.  The basic problem for the troubled economies of Europe is that they had not taken heed of this until their debt to GDP has gotten out of control.  The US has at least $66 trillion dollars in unfunded healthcare and pension liabilities up to 2050 and some would put this figure at closer to $100 trillion (yes trillion). 

    We thus have a choice.  We can either cut benefits or raise taxes or perhaps both.  The sad fact, however, is that these trends have been emerging since the 1970s but only now are we really facing up to them.  

    See: The Demographic Cliff, Harry S. Dent, (Australian edition) Schwartz Publishing, 2014.


  7. Department of Health and Human Services Tasmania says:

    Health costs are rising and like it or not Doctors are part of the problem.  I have been in practice now for more than 40 years as a General Practitioner and Specialist and have experienced pre and post Medicare “Illness funding systems”. Universal Health Insurance is, I believe a necessary part of a civilised society and it needs to be managed well and funding and expenditure needs to be reviewed.  I don’t think Co-payments will do more than add a level of bureaucratic complexity and increasing bad debts to the General Practitioner and deter some patients from accessing health for themselves and more importantly for those more vulnerable with the spectre of more patients presenting in crisis and costing more to the system in the long run.

    How then do we pay for Healthcare? Increase the Medicare Levy proportionally with income, extending the 10% GST to those items which are now exempt (including health) to provide an income stream for years to come. We also need to be a rethink how we reimburse Doctors and pay for Investigative services.  Is it time we barbeque the sacred cow of Fee For Service medicine and do away with some of the perverse incentives of over-servicing and over use of investigative services?  I suspect the majority of GPs in Australia have become involved with Medical Service Companies and are now subcontractors rather than independent small Business people, a significant number of specialists are considering similar moves. Is this Nationalisation by Stealth?

    Surely it is time for a new business model for Medical Practice where practitioners are rewarded appropriately and the practice of medicine is divorced from the number of patients through the door!  This is a nettle that needs to be grabbed!

  8. Dr Peter Bradley says:

    I absolutely endorse the above comments of Dr Paul Dunne.  I have been proclaiming similar sentiment for so long I’m tired of repeating it.  But yes – absolutely – and I repeat his last words…please polititians of all persuasions take note…

    “Surely it is time for a new business model for Medical Practice where practitioners are rewarded appropriately and the practice of medicine is divorced from the number of patients through the door! This is a nettle that needs to be grabbed!”

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