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Itís an emergency!

By Stephen Leeder - posted Wednesday, 3 October 2007

The Australian health care system provides a wide range of services to people with both acute (here and now and likely to get better) health problems and chronic (serious and continuing problems such as heart disease and emphysema) illnesses. By international standards it does this well, even when the comparison is limited to the OECD (Organisation for Economic Co-operation and Development).

About one billion of the world’s six billion live in affluent circumstances where, as in Australia, the high costs of health care are spread across the entire community through taxation. Four of the other five billion people in countries strongly on the way up the development ladder generally have to buy what health care they want out of their own funds, though government help may be there for serious matters. The bottom one billion - many in sub-Saharan Africa and in the poorer reaches of India - get nothing and generally live and die beyond the reach of health care.

So any statements that our system is crumbling, hopeless or in need of palliative care need to be tested against these global facts unless we are to sound like spoiled children.


A recent report from the OECD compares health care systems across the 30 OECD countries, of which Australia is one. The 30 countries are all affluent or relatively so. They range from Ireland, with the highest ratio of nurses to doctors (6.4), to Greece (0.8). The range in acute care beds per 1,000 population ranges from 6.7 in Luxembourg to 1.0 in Mexico. Australia sits in the middle with 3.8, which includes acute beds in the private sector; as we do in regards to the number of doctors, given our population.

When it comes to annual expenditure on health care per head of population in 2005, again Australia nestles in the pack with just over $3,000, a good third of it from private pockets. The US tops the chart at $5,500 and Turkey comes last at just under $600. The US now spends more public money per head on health care than we do in Australia, although we commonly think of the US as a private health system.

That said, there is much that can and should be done to make the service that we offer our citizens a better one, but it is hard for ordinary people to be clear about what is actually going on in health care.

Both state and federal bureaucracies and ministries of health have gone to extraordinary lengths in the past five years or more to shut down public involvement in discussions on health policy: closing sources of information, firing public servants or doctors who speak out, abolishing health boards, and generally silencing any discussion about what is being done, whether it is a problem and how things could be made better.

This silencing has been balanced by numerous high-profile, consultant-led inquiries into the future of health care where day-long seminars of contrived public consultation in expensive hotels achieve predictable outcomes. This is one way to close down the outcries over scandals in our hospitals that were so politically embarrassing a few years ago.

Repeat the surveys that would tell us whether we are winning in our efforts to reduce the thousands of hospital deaths that occur each year through medical misadventure? No thank you!


Measure the dietary behaviour, weight and heart risk factors of our community? Well maybe, but not yet.

Link Medicare data to drug prescription data to detect side effects early? Oh, I don’t think we should do that!

The people and the system have been split apart. Investigative journalism in relation to health is almost dead. We should probably be more concerned about the state of democracy than about the mechanics of the health system. The silence of conspiracy suits those who wield the power.

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About the Author

Stephen Leeder is professor of public health and community medicine at the University of Sydney, and co-director of the Menzies Centre for Health Policy.

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