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  1. 1

    Clive Deverall

    Mark Ragg mentions “wealthy/educated/living in a city and not indigenous”. Add to that not being well informed. Whatever chronic disease you have, especially cancer, you require access to (at the very least) an initial multi-disciplinary review. You are unlikely to get that if you are referred to a private consultant in a private hospital. The surroundings may look nice and you will probably see the consultant with minimal delay. But will you receive multi-disciplinary treatment? Unless you have breast cancer it is unlikely. You are the property of the private consultant who will refer you on to other consultants of his/her choice with little or zero co-ordination. How many people have you met (who are well educated) who claim to be ‘seeing the top person’? Some of them are suffering from self delusion. Well co-ordinated, genuine multi-disciplinary treatment(MDT) (especially for cancer) is still unusual in Australia even in the public sector – despite its merits being identified in several national reviews going back 10 years or more. The threshold for the introduction of genuine MDT in Australia – in both public and private sectors has to be the development of accreditation of services and the credentialling of those health professionals who work in them. Yes – it is ‘work in progress’ – but taking a long time to bring to the boil.

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  2. 2

    Jenny Haines

    There is nothing new about there being social determinants of health status but the question is how to overcome them. Universal access to the health system has been undermined over the last 20 years even though it offered the possibility of more equality in the standards of care received no matter what your social class or income status. The system as structured now, favours those who hold private health insurance, which can move you up a waiting list or ensure that you receive a procedure in a private hospital performed by your own private doctor, that you would wait for in a public hospital and the procedure will most likely be done by that private doctors registrar. This system is supported by our current Federal Government with the private health insurance subsidy up to the tune of $3 billion, while public hospitals and public community health services go begging. This is despite promises by the current government when in opposition that they would abolish the private health insurance subsidy. That was several years ago, before the 2004 Federal Election which they lost to John Howard. Then they dropped this promise from the agenda. But the need for more equity in the provision of health services is not diminishing, it is getting greater – just look at mental health, dental health, indigenous health, migrant and refugee health, adolescent drug, alcohol and sexual health.

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