Below are some links to recommended reading. They cover everything from the challenged role of doctors, and the federal health budget, to inequality, AMA chest-beating, health policy – and the NT Intervention, the NBN and remote Indigenous health…
Questioning the role of doctors
The Drum and The Conversation have embarked on an interesting collaboration “to give statements made by public figures the fine-tooth-comb treatment they deserve”.
A comment now up for scrutiny is this quote from a 2010 media statement by Dr Andrew Pesce, AMA President (now the outgoing AMA president).
“When people get sick or injured or want advice about their health, they want to see a doctor.”
The Drum/The Conversation invited analysis of that claim by a health economist, a prominent advocate of health workforce reform, a pharmacist, a psychiatrist and a nurse practitioner.
• Glenn Salkeld, Professor of Health Economics, University of Sydney, described the evolving role of doctors and laid down a challenge to fee-for-service healthcare: “We’ve got to think whether our fee-for-service system can cope with the weight of community expectations. To avoid our health care collapsing under the financial weight of its own success we need to consider blended funding models that both pays for services delivered and pays for community care on a per capita basis. Increasingly healthcare will be delivered in settings far from the doctor’s practice. That doesn’t mean doctors will become redundant — instead they’ll be an important part of the larger, more coordinated health-care team.”
Read the full article.
• Peter Brooks, Director of the Australian Health Workforce Institute, University of Melbourne, said that one of the biggest problems of doctor-centred health system is its lack of economic sustainability. He said: “Medicine is the last profession on the planet to be restructured. Banks, construction, manufacturing even the legal profession did it long ago….We need to examine the role of the doctor and work out what elements of healthcare need to be managed by doctors, and what can be done by other, appropriately trained professionals.”
Read the full article.
• Lisa Nissan, Associate Professor of Pharmacy at University of Queensland, said pharmacists’ skills and knowledge are still the most under-utilised in our health system. “If patients can’t get in to see their GP for a repeat prescription, pharmacists can’t dispense the patient’s regular contraceptive pill, adjust their dose of warfare and replenish the medication supplies of recently discharged hospital patients. There is clearly scope to better utilise pharmacists’ medication expertise to take on more of the prescribing load from GPs.”
Read the full article.
• Jon Jureidini, Professor of Psychiatry, University of Adelaide, said many patients with less serious mental health problems do not need to see psychiatrists. “So let’s restrict the use of scarce specialist resources to when we are confident they can make a difference, let GPs take the lead with most mental health presentations, and encourage people to consider ways of making sense of their distress that don’t involve giving it a medical label.”
Read the full article.
• Catherine Hungerford, Endorsed Nurse Practitioner and Assistant Professor of Nursing at University of Canberra, said nurse practitioners can improve the experience of patients in emergency departments, as suggested by the popularity of the Walk-in Centre in the ACT at the Canberra Hospital, which was visited by more than 10,000 patients in its first twelve months. “People are voting with their feet – towards the Nurse Practitioners,” she said.
Read the full article.
The series takes on an interesting significance in light of incoming AMA president Dr Steve Hamilton’s (correction: of course, I meant to write “Hambleton”, apologies for my Friday-night error) promise to be more aggressive with the Government (presumably this chest-beating is directed as much at AMA members as at the Government).
You can see my response on Twitter here.
The series from The Drum and The Conversation reinforces the sense that the rise and rise of online media and commentary is challenging many of the powerbrokers of the old status quo (and not only the heritage media).
What can we learn from the budget?
At the Centre for Policy Development, health policy analyst Jennifer Doggett gives a thoughtful and comprehensive analysis of the federal health budget. A few snippets:
• A major challenge for the Government in implementing the mental health initiatives will be to balance the interests of the different groups and maintain a strong focus on the needs of consumers, rather than being swayed by the political influence of providers and interest groups.
• From a political perspective it’s worth asking why mental health received such a substantial funding boost to the virtual exclusion of other areas of health care, she said. “The take-home message” from the successful mental health campaign for other health groups is to “never underestimate the power of a well-planned and executed lobbying campaign by a united (at least temporarily) sector.”
• “Overall, the Treasurer has delivered a predictable Budget for a Government in the middle of a health reform process in a non-election year. Other than the mental health initiative, the aim of this Budget is to keep the health system ticking over and the reform agenda progressing without making any major outlays.”
More on the debate over cutbacks to the Better Access program
The Medical Journal of Australia has done a very quick turnaround in publishing two opposing articles on whether the budget reforms to the Better Access to Mental Health Care initiative are appropriate.
• The changes were too timid, and more wide-ranging reforms are needed, say Sebastian Rosenberg and Ian Hickie, from the University of Sydney, who are longstanding critics of the program. “There is a clear role for GPs in coordinating genuine primary mental health care,” they said. “At present, that role is largely vacant. The timing is right for the professions to abandon self-interest and argue for a planned, evidence-based overhaul of the Better Access program.”
• But two academics who evaluated the program (Jane Pirkis, University of Melbourne, and Meredith Harris, University of Queensland) say it has many positives, and appears to provide good value for money. “We believe the Budget reforms have struck an appropriate balance between retaining the core features of a program that appears to be working well while at the same time providing additional resources for important existing and new initiatives,” they said.
The NT intervention and unintended consequences
David Dalrymple, a prosecutor with the NT Office of the Director of Public Prosecutions (writing at The Drum in a personal capacity), describes some negative effects of the NT intervention’s alcohol policies.
A sad consequence of the Intervention is that the legacy of the older community members (a great many of them now deceased) whose authority and wisdom delivered the patchwork quilt of restricted areas that existed up until mid 2007 has been forgotten in the tide of resentment felt by many if not most residents (in particular younger people) affected by the package of Intervention measures about what they perceive as unjustified government interference and imposition. The debate about whether or not that perception is valid will continue for some time yet, but the damage in terms of the undermining of a pre-existing community consensus on grog has been done.
The challenges of the NBN and remote Indigenous communities
At Inside Story is an engaging essay about the challenges facing the rollout of NBN to remote Indigenous communities – as well as its potential. It is by Ellie Rennie, a Senior Research Fellow at the Institute for Social Research and the ARC Centre of Excellence for Creative Industries and Innovation. A snippet:
By promoting e-services to regional and remote areas, broadband policy is, in theory, going against the tide. If the ambitions of the NBN are realised, choosing to live “on country” doesn’t have to mean sacrificing basic living standards or engagement with the outside world. Although the expense of undertaking an assistance program might be high, it’s worth considering what it could save in the long run. The NBN will enable e-health and e-education, connecting households with services, markets and shops, making otherwise isolated communities more viable places to live. For sufferers of chronic illness it could provide better ongoing care from health practitioners who can’t always be there in person. The NBN might not perform a remote leg amputation, but it might help prevent one in the first place.
Beyond the $150,000 debate
Perhaps rather than expending so much discussion on the question of whether an annual income of $150,000 makes you rich, we could be considering the needs and experiences of those at the other end of the income spectrum. Andrew Leigh, Federal Member for Fraser, reminds us in a piece at Inside Story how the income gap is widening in Australia and other countries.
Now that’s a health issue that deserves far more attention than it generally gets…