The health system is a social indicator

This series of articles is about the varying views of Australia today. Let us consider our health system when we consider the current Australia. People might think this series is solely about economic matters but the quality and reach of our health system helps measure whether or not we are a truly civil society.

So let us have a look at the health system we have. It might tell us something about our society, about our values, and about our aspirations.

First, our health system is really an illness system and its name is not an indication of what it is really about.

It is concerned with medical services; with the provision of pharmaceutical drugs; with the numbers of hospital beds; with the numbers and adequacy of many services; with the staff needed to service the facilities we have; with the actual numbers of staff we have; with shortages of staff now and in the future and with rationing as it exists and manifests itself in Australia.

There is altogether too little health related work in prevention - although a lot is known and we could do a lot more using this present knowledge.

Australia has a vicious two-tiered health system. The affluent and powerful go as private patients generally and when they go as public patients - as a former Prime Minister did with a family member – they receive special and quick attention.

They have enough money to pay medical practitioners; they have enough money to pay for pharmaceuticals for themselves and their families and to purchase services privately.

They have good rates of compliance with treatments and with instructions they receive from those who care for them (they are educationally similar to those who write the health messages). They do not have to wait for services and they know how to make systems respond to them.

They lead healthier lives, undertake more preventive activities, avoid smoking and drinking to excess, exercise more, and so on. They find it easier to understand health professionals.

Those who are poor and powerless often cannot pay the doctor; often cannot pay for pharmaceuticals; cannot purchase services privately; have poorer rates of compliance; eat, smoke and drink more and have demonstrably worse health outcomes.

Queues for admission, treatment and for devices are longer in the public sector; the public sector has worse food, worse conditions (males and females share wards in many public hospitals), dirtier hospitals and busier, more demoralised staff.

There are chronic shortages of staff - advertisements are slow to appear, and when they appear there may be few or no applicants for positions. In public psychiatric hospitals (and elsewhere) patients are occupying beds inappropriately in acute wards because "step down" facilities are not available.

The poor and powerless drink more, smoke more, practice preventive measures less and find it more difficult to understand what health professionals say. And yet the public system often takes the sickest, the most complicated and the most difficult - and the super specialised hospitals shine here.

What exists here is scarcely an indicator of a civil society. It is certainly not an indicator of a fair society. It is scarcely an indicator of a caring society.

The current unsatisfactory situation is compounded by old and creaking administrative arrangements between tiers of government - those arrangements persist when they should be changed as a matter of justice.

Those with control of budgets know that there are inequalities - inequalities between rich and poor, between powerful and powerless, between urban and remote Australians, between Aboriginal and non-Aboriginal Australians, just to mention some.

Decision makers live with these inequalities. They accept that some people cannot find beds. They accept that some people cannot access the amount of services requested for them. They accept that some people miss out on services - for example, and shamefully, the lack of residential care for aged people. They accept that some people get sub-optimal access, or care, or results. They do not provide a greater share of the tax cake to "health" services - partly because to do so would mean that some other area would have to receive less.

What is very disturbing is that our system is certainly better than the public healthcare system of the United States and probably better than the entire United Kingdom healthcare scheme. In the United States, there are few and poorer services for indigent people, and in the United Kingdom queues seem to be longer for almost everything.

That seems to tell us that the inequalities affect some countries emotionally less than they should. There was vicious opposition to a proposal from President Obama to extend more medical care to more people - morally bankrupt behaviour from the opponents.

The shortages of staff that exists in Australia, sits poorly beside press stories of properly qualified practitioners from (say) Canada being forced to do language tests and finding registration difficult in this country.

Our learned colleges are proud - and rightly so - about the high standards they set for anyone who would obtain one of their qualifications. But there is a disconnect between those high standards and the difficulties too many qualified people face to be allowed to practice at all.

There is no need for our colleges to reduce any standards, but there is no sense in the universities having some stranglehold over registration. It seems to me the recognition should be made easier and that the colleges should maintain high standards. Both are possible. The Australian polity would be better off with such a system.

Some of our work practices also need attention. For example, Australia's anaesthetics practice, where too little use seems to have been made of anaesthetic nurses.

Another is our failure to ensure the supply of enough physicists to care for all our radiotherapy machines. There will be marked shortages of people to do caring jobs in the decades ahead - we know now where the shortages will be and what they will be - and we are doing too little to plan now to meet those shortages. Such shortages are due, in part, to a rapidly ageing society.

So there you are - an unequal system, political masters who know that it is unequal and who do too little to make it more equal, looming great shortages of staff, and a general lack of qualified people.

It is just not fair.

Such a system should appal us - but the evidence seems to be that people accept the situation with equanimity and with too little determination to make it better.

You might read other articles in this series that concentrate on our riches, our promise, and our high standard of living - but they ignore the inequalities and the inequities that exist right now and which should, as a matter of justice, grab our attention and make us determined to fix them.