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Putting a stethoscope to the patient

By Andrew Bartlett - posted Tuesday, 16 October 2007


Without political leadership to usher in the reforms which are necessary to address the health care needs of Australia in the 21st century, we are at risk of ending up with an expensive skeleton of a health system that neither addresses health service provision nor meets community expectations.

Local and international evidence points to the steps that we should take to make the necessary reforms.

Currently we are too hospital-centric, endlessly focusing on hospital waiting lists and overcrowding in emergency departments.

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We will always need acute hospital services but we could provide more appropriate care for many people through better access to community based multidisciplinary primary care teams which would include GPs, nurse, allied health professionals and other health workers. This should be the cornerstone of a National Health Policy - something we still do not have.

But we must also move from supporting healthcare - or more correctly sickness care - which provides episodic management of ill-health to models of health care which support preventative care and health promotion to a much larger degree.

Prevention of sickness in the first place is one obvious way to try and reduce burgeoning health care budgets. We currently spend less than 2 per cent of the health budget on preventative programs. And there are good reasons why we should increase spending on preventative care.

Take smoking for example. Although Australia has had remarkable success with reducing cigarette smoking rates, smoking still remains the greatest single preventable cause of premature death and disease in Australia, killing almost 20,000 people each year and costing the community an estimated $21 billion per annum.

Similarly, obesity which is on the increase is already estimated to cost the Australian community almost $4 billion a year - $21 billion a year if you include the burden to individuals of living with the disability and illness associated with obesity.

Health is our largest industry, with almost 600,000 employees or 7 per cent of our civilian workforce, but we have yet to seriously tackle the workforce crisis.

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We need to be making better use of our existing workforce and that means reorganising the roles and responsibilities of our health professionals and in some cases creating new professions. It also means opening up MBS funding to other health professionals.

We often hear that we do not have enough doctors but many procedures carried out by doctors and specialists could be done by other health professionals. For example only 10 per cent of normal births are delivered by midwives in Australia. In the Netherlands it is 70 per cent and in the UK 50 per cent.

Nurse practitioners, who prescribe medications, initiate tests and X-rays, refer to specialists, and admit and discharge patients, now number 65,000 in the US and are entrenched in its health system. In Australia, they number 100.

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About the Author

Andrew Bartlett has been active in politics for over 20 years, including as a Queensland Senator from 1997-2008. He graduated from University of Queensland with a degree in social work and has been involved in a wide range of community organisations and issues, including human rights, housing, immigration, Indigneous affairs, environment, animal rights and multiculturalism. He is a member of National Forum. He blogs at Bartlett's Blog.

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