Continuing on from the previous post, my reading of the National Health and Hospitals Reform Commission report has yielded some quoteable quotes, interesting snippets and a few oddball moments.
Quotes and snippets:
“This opportunity for major health reform is rare and highly anticipated. There is a unified call for action from the health industry and those it serves to get it right for future generations. These pressures have been recognised by all levels of government and they are listening. We have an extraordinary moment in time in which to redesign our health system for the future with the collaboration of governments, clinical leaders, and the collective goodwill of the people of our nation.” P 45
“One of the strengths of the Australian health system is that it has a combination of private and public financing as well as a competitive mix of private and public health care delivery. Nevertheless, there are signs that the competitive tension between private and public hospitals has become unbalanced. Ore and more, patients who can afford it are seeking planned surgical and procedural care in public hospitals. The attraction of better financial rewards and conditions in the private sector has resulted in surgeons and other proceduralists moving increasingly or exclusively to the private sector.” p51
“Inconsistent and unequal access to appropriate services and health outcomes is causing many Australians unnecessary suffering. The Australian way is to give all a ‘fair go’ and we know that this is not the case for many people.” P 52
“…the people most in need are likely to have the greatest difficulty in getting the right care. Sometimes, such patients end up literally ricocheting between multiple specialists and hospitals, not getting access to community support services, and having endless diagnostic tests as each health professional works on a particular ‘body part’, rather than treating the whole person.” P 103
Almost 20 per cent of older patients in public hospitals would be more appropriately cared for outside an acute hospital. P 54
Our lack of access to affordable dental health services means that Australian ranks among the bottom third of OECD countries for rates of dental decay among adults. P 83
“We know that too many diagnostic tests, medicines and procedures that are performed are unnecessary, inappropriate, and even sometimes harmful. Many are not cost-effective, lack an evidence base, or are simply duplications of tests.” P 55
From a submission to the Commission: “In every dimension and at every level, the Australian heath system is not just fragmented but atomised. Like iron filings scattered randomly on a piece of paper, its many players are influenced by different motivations, which in turn draw them in different, often opposing directions…More than ever, the Australian health system is in need of a magnet to align its efforts – strong, determined leadership fuelled by a bold, unifying vision.” P 68
From another submission: “There is no shortage of excellent policies in the Australian health system – the problem is implementation, not policy.” P 165
From another submission: “Putting a young intern into a modern emergency department or intensive care unit with the current average level of systems support is like expecting a new graduate stockbroker to manage an intricate portfolio on today’s sophisticated financial markets with little more than a ball-point pen and a slide rule.” P 128
“..there is increasing frustration and mounting cynicism with the pace of action on implementing a national e-health platform.” P 131
“..remote and rural communities have often been the ‘incubators of innovation’ when it comes to providing creative solutions to health care.’ P 89
“To retain the benefits of mixed public-private financing, we have recommended that the overall balance of spending through tax, private health insurance and co-payments be maintained over the next decade. However, we want to stress that this does not mean that we should not vary the mix of public and private financing for particular types of services.” P 159
“We urge governments to continue consultation and engagement with the community, health professionals and health services – successful implementation of the reform agenda will depend on it. Change is more easily achieved, and with better results, when it is informed by the views and with the active involvement of those affected.” P 167
“…there should be three measures of success of our health system: measures of the performance of the health services, of the public’s confidence in the health system, and of the satisfaction of those working within it.” P 167
“There are advantages in our federal system with two levels of government sharing responsibility for health funding: they share the financial costs and risks of ill health, and reforms are often more highly scrutinised when cooperation between govenrments is required; health services managed at the sub-national level are often more responsive to local need; and there is scope fior greater diversity in developing and implementing innovative solutions to unique circumstances and policy problems. States are also better equipped to take an ‘intersectoral’ approach to health care because they are primarily responsible for many other areas of public policy – education, police, housing and transport, for example – that have a major impact on health outcomes.” P 145
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The report also contained a few comments that just seemed, well, odd. For example:
• “We often devote more attention to the health and wellbeing of our family, our friends and even distant communities, than to our own health; that is what makes us human – our altruism and our fallibility.” P 46. (I’d love to know the evidence for this statement; reading between the lines, it sounds rather like one of the Commissioners – or maybe all of them – were feeling that their task was overwhelming their health.)
• “The environment in which we live may in future have an adverse effect on our health and wellbeing as the ambient temperature rises and climate variability worsens. Climate-related thermal stress, microbial proliferations, vector borne infections, impaired nutrition, and poverty are all possible consequences of the accumulation of greenhouse gases at the Earth’s surface. On the other hand, greater awareness of the harm we are doing to our environment may encourage people to strive to live healthier lives, which are kinder to themselves and their surroundings.” P 65 (Again, I’d love to know the evidence for this last statement; it sounds rather Pollyannaish to me, and that’s coming from someone with Pollyannaish tendencies herself...)
“While Galileo was excommunicated for suggesting that the earth revolved around the sun, we don’t think it is too heretical to suggest that primary health care services should be the axis or pivot around which we seek to develop a person-centred health system.” P 102 (This seems a rather extravagant analogy – the Commissioners aligning themselves with Galileo..)
Still, I suppose a touch of rhetorical flourish helps the medicine go down…
