Want to Reform Healthcare? Start with the Workplaces

According to the World Health Organization, the U.S. spends by far the most per capita on health care but by most measures ranks not even in the top 30 countries in terms of health-care outcomes. If we want to improve Americans’ health and reduce our health-care expenditures, we need to understand why. There are many causes, of course, but I’m convinced one of the most important — and most overlooked — is our work culture. Working in America is literally hazardous to your health.

Read the rest of this interesting opinion piece by Jeffrey Pfeffer of BNET.

NHHRC Report Dissection

The National Health and Hospitals Reform Commission’s report is being gradually dissected by various stakeholders. Here’s a few quotes from the big fish (courtesy of the AHHA).

Australian Medical Association Federal President, Dr Andrew Pesce: “(It) is clear that (the report) properly focuses on some critical areas in health. The AMA’s objective now is to ensure the emphasis on the needs of patients is reflected in the final policy. In particular we want to make sure any extra funding goes to the bedside, the clinic and the surgery – not into more bureaucracy.”

Australian Dental Association, federal president Neil Hewson told ABC News Online: “The long awaited final report of the National Health and Hospitals Reform Commission released by Prime Minister Kevin Rudd demonstrates the same lack of appreciation of dentistry and the problems with dental care delivery as the earlier Interim Report. Those people who already have access gain more access and disadvantaged people are still disadvantaged so therefore we believe targeted programs of funding is the best way to ensure that disadvantaged actually do get their dental health improved dramatically.”

Australian Nursing Federation Federal Secretary Ged Kearney: “Community access to good quality primary health care is pivotal to easing pressure on the public hospital system. The widespread establishment of these centres and services, run by teams of health professionals is a positive initiative. Aged care is in desperate need for good reform, the population is ageing, people’s care needs are increasing and nurses and assistants in nursing are under intense pressure. But putting the burden of funding on older Australians, perhaps forcing them out of their homes, because they are in need of high level care is not an answer.”

Mental Health Foundation of Australia: “What (Medicare Select) would enable people to do is actually cash out all the services they might normally get through the health service system and use them in ways that will benefit them,” chief executive David Crosbie told ABC News Online. “That might mean improving their access to housing, improving their access to employment, improving their access to other supports that are actually going to make a difference in how well they cope. What we need to do is put in place a whole range of better access points and ways for people to access mental health services, and better quality services. That means not just more money, it means re-orientating the current health service system so it is actually responsive to people’s needs, and that means a lot more than simply putting money in.”

Public Health Association of Australia President Professor Mike Daube: “We welcome especially the emphasis on prevention and on other important issues such as mental health, Indigenous health, dental health and palliative care. PHAA is particularly pleased to see strong support for the establishment of a new National Preventive Health Agency.”

The Rural Doctors Association of Australia: The association’s president, Dr Nola Maxfield, says the commission has forgotten to include recommendations on how to encourage health workers to remote areas. She says recommendations such as locum relief and reducing HECS have already been tried, and only higher wages and improved working conditions will encourage doctors to go bush. Dr Maxfield says if something is not done now, things are only going to get worse. “The doctors are getting older and more tired and the young ones are not coming up,” she said.

John Della Bosca: argues that the election of the Rudd government and the commitment of the states and territories to work collaboratively on public health presents a once-in-a-generation opportunity. Yet the debate about how we turn this opportunity to our collective benefit needs to be much more than a turf war about which hospital department is funded by which tier of government.

Fiona Armstrong, Centre for Policy Development: argued that the National Health and Hospitals Reform Commission’s report puts forward a weak and flawed approach that will further entrench the blame game and cost-shifting. She also said that the proposal to hand control of primary health care to the Federal Government but for the states to continue to be responsible for hospitals will do nothing to deal with the issue of inequitable access.

Dr Jeremy Sammut, of the Centre for Independent Studies: argued that increasing government funding to increase the number of public hospital beds by 15 per cent is a one-off solution that will not solve the issue. Instead, the National Health and Hospitals Reform Commission, which has made 123 recommendations to improve the nation’s health system, should have focused on cutting bureaucracy. Dr Sammut is the author of a report, issued last week that finds Australia’s public hospital beds rate 2.5 per 1000 people is well below the OECD average of four beds.

Allied health: The National Health and Hospital Reform Commission has called for extra investment of $140m to $330m a year to dramatically expand the number of services provided by allied health services on referral from a general practitioner. The commission also proposes allied health workers be able to refer patients to medical specialists to ease the logjam at doctors’ surgeries.

Tony Abbott’s plan for hospitals: A Coalition Government would devolve the running of the nation’s public hospitals to the private sector, community groups and charities, Opposition frontbencher Tony Abbott says. “We wouldn’t run them with public servants,” he told the Ten Network on Sunday. Mr Abbott, a health minister in the previous Howard coalition government, said it was time to give the public hospital system back to the people. His vision includes the establishment of local hospital boards with the power to appoint their own chief executive and the ability to retain revenue from privately-insured patients. “It is a dog’s breakfast of divided responsibility,” Mr Abbott said of the present system where the states blamed the Commonwealth for lack of funding. The Commonwealth, under a coalition government, would devolve management of public hospitals in the same the way it did for the employment services network and nursing homes.

My TOP 4 summary:

1. Encourage the establishment of primary care centres where allied health and GP’s work as a team. There are too many disincentives to go into general practice at present.
2. Open up health training to make roles and responsibilities more flexible (prevent closed-shop systems).
3. Give patients more tools to manage their own health including better information about prevention, access and treatment options.
4. Sell the hospitals, or at least make them accountable (I agree with Tony).