Federation, fee-for-service medicine and other problems in Australian health care

Fee-for-service medicine has its place but in its dominance in GP-land it causes doctors to chase not only dollars but patients out the door as fast as possible. Elements of capitation and target payments are needed. GPs' incomes and status need to be improved. Separating themselves off in their own union (as happens in Denmark) would make good sense as AMA politics currently is dominated by the hospital doctors. Medicare primary health care needs to be more explicitly recognised as the metropolitan construct it is. In the bush, but also more generally, we need much more experimentation in the organisation and remuneration of primary health care and greater acceptance of the need for local "horses for courses".

It would be more efficient and more equitable if the public health-care system were funded totally by the Medicare levy and if this were to be made much more progressive. Certainly, doing away with the iniquity and inequity that is the 30 per cent private health insurance rebate is needed.

The lack of compassion, and in turn resources, from government for aged care and the mentally ill are a national scandal. Do politicians ever visit aged-care facilities? Have they ever tried to get support for a relative or a friend with mental illness? Allocative efficiency is distorted by the chronic inefficiencies and lack of budget integrity of teaching hospitals. Their overspending is a function of the power of the AMA and the lack of leadership politically and administratively to control both that spending and the AMA. The opportunity cost of that to the mentally ill, the elderly and Aboriginal people is conveniently forgotten, ignored, pushed aside.

Which brings me to my greatest wish for the Australian health care system: compassionate, strong leadership and good sound management.

Currently we lack both.