Health: Where to from here?

This is truly THE global question today. But just as the Nobel peace prize committee has established itself as a questionable zeitgeist, I fear many health reform commentators are doing little more than talk. This beckons a general comment about two important recent developments, and a personal statement about the future of this blog.

There have been two announcements that made me sit up and take notice of late. Actually, make that three.

The first was from Dr. Ezekiel Emanuel in a speech to the Medical Group Management Association annual conference in the USA. I quote, “The problem in the system (healthcare) is not that we don’t have the right technologies,” said Emanuel, chair of bioethics at the National Institutes of Health, in addition to being the older brother of White House Chief of Staff Rahm Emanuel. “It’s how we connect with patients.”

That statement – how we connect with patients – sums up what I believe is the unstated need central to healthcare reform. Too many people are approaching things from an economic or systems focus when ultimately, everything depends on patient needs. This truism deserves more explanation.

Emanuel went on to speak of increasing this connection by making healthcare accessible in non-office settings including online. He also advocated such things as non-physician care when practical, on-site health clinics at large worksites and even a return to house calls.

This leads onto the second and third developments of late. The second is that NEHTA announced a shift in strategy on Australian health records. Realizing that a national centralized behemoth was never going to happen this century, they’re turning to industry to tout their wares. This is a great and sorely needed shift.

The third was a lonely voice crying in the medical training wilderness of Australia.

It comes from Michael Moore, not the doco-joker, but former ACT health minister. He says Australia’s medical colleges should hand over responsibility for training specialists to universities.

Now chief executive of leading advocacy group the Public Health Association of Australia, Moore said the change would lead to more trainees, easing fatigue loads. He said overworked doctors could thank the closed-shop attitude of their supervising colleges for ensuring trainee numbers “aren’t too high”.

“The training and control of who gets into the specialist programs is in the hands of colleges and it’s a poor system because it clearly suits the colleges to have fairly restrictive entrance,” he said. “If they maintain a relatively poor supply and a high demand, obviously they’re going to make more money. The logical system would be to take the training completely away from the colleges and move it to universities.”

This surely suits the current governments reform agenda. They are clearly frustrated by the closed-shop attitude of several medical colleges. The question is how this can be done?

These last two changes both point back to the first: health reform should begin with, and target, areas where patient needs can be met. Other changes will then follow more easily. If we go after big and immovable targets we will fail. but if treat health as the dynamic marketplace it is, and meet patient needs, the resistant stakeholders will be forced to follow lead. The introduction of patient controlled records and the broadening of medical training are key steps in this direction.

I want to finish by apologizing for my lack of posts in recent weeks. While busy with other things, I’ve also had some time to think about where to spend my time in the near future and am considering wrapping up this blog. Or at least rolling it up into something more specific such as a tool for research/reports on advancements in primary health management. I see little value in generating more gas around this roaring healthcare fire and hope to capture and funnel this heat towards building something worthwhile.