Australia's poorly health service

"Not so organised chaos"

The Queensland Outpatient Review Committee chaired by Professor Ken Donald, Head of the School of Medicine at Queensland University, made some startling revelations in its report of June 2007.

Each of the five hospitals reviewed - Royal Brisbane and Women's, Princess Alexandra, Gold Coast, Cairns, Rockhampton - had a system in which some names on the out-patient waiting lists carried the label "NEVER TO BE SEEN". That is, the likelihood of these patients ever being given an appointment was zero, but neither they nor their GPs were informed.

"It was evident ... Queensland public hospitals are struggling to effectively cope with ... increases in demand resulting from Queensland’s growing and ageing population", the report stated. "Access to specialist outpatient services has not been a priority for Government ... Unacceptable waiting times for specialist outpatient appointments are increasing the risk of adverse clinical outcomes for a significant number of patients, particularly those who are assumed to be non-urgent".

Patients and GPs were not advised of waiting times, innovative models of care have not been widely adopted, and indeed there were references to "not so organised chaos" in some hospitals.

On 1 March 2007 there were 143,900 Queensland people waiting for new appointments, an increase of 18 per cent in a year. However, "the level of funding ... was not commensurate with the increasing rates of demand … resulting in longer and often clinically inappropriate waiting times ... increasing the risk of adverse clinical outcomes for a significant number of patients".

The Committee was alarmed by examples of even the most urgent patients waiting more than 12 months for appointments, some forced to attend emergency clinics.

In March 2007 the co-payment for private specialist services increased 33 per cent compared with 2004/05, while out of pocket expenses increased 150 per cent since 1996. Accordingly, there was an increase in the number who could not afford private treatment and they joined the public waiting list.

The committee recommended all public out-patient services be funded by the Australian Government as a priority.

There was a reluctance to discharge patients back to GPs and adopt innovative alternatives to surgery including physiotherapy and holistic health care. Savings could be made by the use of modern communications, including sending information to distant GPs by email so patients can avoid travelling great distances for brief appointments.

Why do politicians lack interest in public health?

The shortcomings of the public health system do not seem to impinge on politicians' consciousness. Is that because they only use the private system?

Or is there something more sinister at work? Are there Australian politicians who want the public health system to disappear because they believe everyone should pay fees?

This is the theme of Naomi Klein’s The Shock Doctrine, describing in great detail how followers of Milton Friedman and his Chicago School of Economics argue the perfect society is created by having an entirely free-market system for all purposes. No public housing, schools, hospitals, welfare systems, no basic wage, no pensions. She quotes such developments, often short-lived, in Augusto Pinochet’s Chile, Thabo Mbeki’s South Africa, Margaret Thatcher’s UK, and the USA under Richard Nixon, Ronald Reagan, and most of all under George W. Bush and his neoconservative colleagues Dick Cheney and Donald Rumsfeld. The new Iraq is being designed in Friedman’s privatisation image, with US private company security guards increasingly taking over from government troops.

Could Australia’s public health system go down that path?