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Expectations in health

By Don Aitkin - posted Tuesday, 25 August 2015


We know that as Australians get older they need more health care. We are building more homes for the very old, who do need a great deal of care. We are urged to take good care of ourselves, eat properly, exercise, give up the fags, stay off the booze. But there is no doubt that as the age goes up the wheels begin to fall off the cart, and we need to go more frequently to see the doctor, the dentist, the eye specialist, the hearing people, the podiatrist, and their colleagues in other specialities.

And there seems to be a wide expectation that somehow all of this should be free. We could of course legislate so that it was all free, to everyone. We would then have long queues, some poor-quality attention, and no doubt higher taxes. Characteristically, given that we are a mixed-economy society, we have a bit of public and a bit of private. A good deal of medical attention is free, and the older we get the less expensive it is. You can also buy some insurance, which is not cheap, that will help you offset to some degree your hospital and ancillary care costs.

It was R. G. Menzies who first tried to put in place a national insurance scheme that would have provided health care for Australians. That was in 1939. It didn’t get up. Earle Page, one of Australia’s most inventive politicians, brought in a National Health System in 1956. You needed to subscribe, but it was cheap. Medicare came in with the Whitlam Government, but it didn’t cover everything, and it has been fiddled with ever since.

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In a separate online conversation I came across a most arresting account of what it is like to be on the other side of the health-care system. I know that if I go to my own GP at the end of the working day my scheduled appointment will be late. I’m used to that, and he’s been my doctor since 1980. I know why he’s late: he gives consideration and attention to all his patients, not just me.

What now  follows is from a medical specialist whom I don’t know personally. I have edited it, in part to remove any indications of place or area, in part to make it flow better. In my view it is a most thought-provoking read. The writer was responding to a reported example of extreme patient rudeness.

Time is a difficult issue in healthcare. Most of us try to do our best — but how long will that take? The patient’s description over the phone cannot tell anyone how much time that condition in that body or mind will take to diagnose and manage, and yet we are expected to be “on time” for them.  Often, they don’t seem to give a hoot about anyone else’s time. Anxiety is understandable (the patient asks for diagnosis as they say hello ), but rudeness is another thing.

I do agree that the real ideal — free health care to all — is admirable, though in my view free food,  basics and water should come ahead of that. But over time, being ‘free’ will shift health care from being a privilege to a right, and we suppliers will come to be viewed and treated as servants, to the point of behaviour that is completely unacceptable. We now have two generations who have come to believe that healthcare here is free, and that deliverers are to adhere to that dictum. Our Medicare levy in truth pays only a ninth of per capita healthcare consumption. The Medicare rebate was to be indexed for inflation via CPI, but that has not been the case except for the first few years. It has now been fixed for two years. Meanwhile the cost of supplying the staff and the phone and the room space goes up, and doctors who don’t bulk-bill for the rebate get bashed in the media.

Maybe lawyers do get greeted like that. I don’t know.

One of the worst examples of unbelievable rudeness I ever encountered came from a woman who had the first appointment of our day, at 0800. By chance I had to go at short notice to a hospital call. We usually don’t have many urgents in our practice, but this was one. So a colleague saw the woman at 0800, and did all of the tests which were needed, but I didn’t see the woman about her long-standing condition until 0845. I then spent half an hour with her, and then she exploded, again, at our admin staff.  Then she rang from home to say that I should only book one person per day, so that I could always be on time! She did not come across as psychotic, but clearly I did not meet her expectations.

Maybe we need a solar-panel equivalent of the great oil well in Australia that could pay for everybody’s healthcare. Our population seems to have come to expect that they don’t have to contribute any personal dollars at all. Medibank, now private, has had to bring in restrictions on what it can afford to cover, and yet still stay solvent. They can only cut costs to a limit. They need staff to manage the company, and also provide the administration and give service to those who wish to insure with them. They also need to look at how much they pay out to hospitals and those who deliver the care when an insurance claim is made by one of their clients.

But unless premiums go up insurers can only cut costs so far before they go out of business. Patients seem to blame their insurer for being miserly, but the dollars have to come from somewhere, as in car insurance. But punters regard health care as being for free, so if they have to pay out anything, it is the insurance company’s fault, or the hospital is to blame. Hence the Medicare stoush with Calvary, the insurer cutting its outgoings. I feel for the insurers — they are under real pressure. At some stage, given the increasing consumption of health care, someone will have to put in more dollars. Perhaps honesty will come to the media, and the population will get real, instead of playing the present pass-the-parcel blame-game. No wonder NIB looks at sending some of their insured patients off-shore, in the hope of cutting costs. I wonder if they ever asked people at the coalface here about our realities.

There was more than this, but you get the message. The emailed letter was to other health-care professionals, not a public statement, so I take the anxiety and perceptiveness in it as factual. It does give you something to think about. I have been with an insurer since 1956, and it does cost money. I think that my wife and I pay about 10 per cent of our income in health-care costs, broadly defined (includes levy, HCF Top Cover, prescriptions, other ancillary health-care services, and our out-of-pocket contribution). I expect that will increase as time goes on. Not only that, health, medicine and how to look after ourselves occupies an increasing amount of our time, too. There is no silver bullet for this issue, in my opinion.

But the writer is right to talk about a ‘blame game’.

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This article was first published on Don Aitkin.



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About the Author

Don Aitkin has been an academic and vice-chancellor. His latest book, published in 2015, is Turning Point, the second novel in The Hogarth Trilogy.

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