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    I believe that everyone in health has a very clear conflict of interest… workers, administrators, patients and their carers. I am unsure why any particular group would be fair minded or altruistic about the allocation of resources. Healthcare is becoming very expensive…..we need to decide how much (as a country) we are willing to spend on universal care and prevention. There is very clearly a waste of money in the current public system and it would be easy to fix it….but then why don’t we increase the drinking age, the price of alcohol and cigarettes……why do we spend millions of dollars immunising people against the flu in spring etc?

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    Doctor Whom

    The fact that Abbott was a health minister with public commitment to “doing nothing” to the health system means its hard to take him seriously on health matters. In addition he appears to be a bit lazy and not very interested in understanding issues in depth.

    The big worry is the current health debate is really designed to fix problems in NSW and QLD.

    Boards managing hospitals? Big deal in Victoria – we’ve had them in one form or another for 30+ years. Sure they are the creatures of the Minister of the day but they work.

    Boards managing Community Health Services? – Big Deal. We’ve had them too since the 70’s. Some members appointed by the minister others elected from their communities. It works.

    Not only is there a problem in couching the health debate in terms of hospitals. Even within those limited terms the debate is narrow and dangerously wrong. We hear frequent calls for more hospital beds. Minsters evaluate funding proposals on “how many new beds can we announce”.

    A big part of the volume in hospitals is day procedure.

    Operations where people are only in the hospital for a few hours or so. This is an area of rapid expansion and demand.

    The need is for more day procedure centre de-coupled from acute /emergency demand and bumping of patients and list. Many day procedure do not even need to be close geographically to high tech tertiary hospitals. Improved day procedure facilities free up beds in hospitals and reduce waiting lists.

    But politicians (and frighteningly Canberra Health bureaucrats) do not understand day procedures or modern medicine. They still think in terms of beds and male doctors in white coats (or the slightly more modern green or blue scrubs).

    Improved aged care (and primary care for chronic illness) will free up hospitals. A huge volume of A&E attendances, and also hospital admissions, are due to falls in the elderly. Falls prevention programs in the community do work.

    Increasing numbers of dying people are transfered to hospital beds for weeks just to die. People are transfered for home and from nursing homes. Hospital really can do nothing for these people that couldn’t be done better elsewhere. They block beds and die in a industrial sterile environment. Improved facilities for dying in palliative care residential buildings and at home would be better for everyone concerned.

    Regional Health Organisations (RHO) with a high level responsibility for at least 500,000 – 1,000,000 persons (less in rural areas) with a capacity to plan and allocate broad funding (but not run the services) over all health, public, promotion, early intervention, primary care, GPs, research, hospitals, aged care, mental health, palliative care are needed to be able to strike a balance.

    RHOs can have useful consumer patient input, (keeping in mind most consumers don’t want to be consulted or be activists they just want a good enough and timely service) improve health literacy and push money to where real prevention and early intervention will actually and demonstrably work to decrease hospital demand and improve health. (as an aside I have great concerns that much of the prevention support and push is rhetorical and not evidence based – not to mentioned riddled with more conflict of interest than an orthopod on a Fiji Cruise.)


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