Submission: No Compelling Case for COAG/IGA model of National Registration & Accreditation: There is no compelling case or public demand for changing the way doctors have traditionally been educated, trained and recognised. The national interest requires public confidence in the medical profession. Any attempt to de-medicalise the Australian medical workforce will generate public anxiety and uncertainty at a time when Australians want security and predictability. The COAG/IGA proposals should be rejected as there is no compelling case for their implementation. Year: 2008, URI:(archive.php?doc_id=165)
Changes to the NSW Medical Practice Amendment Act 2008 and Related National Issues: The Australian Doctors' Fund is campaigning for changes to the legislation to restore the common law rights of NSW medical practitioners. Failures by hospital administrators and others, despite warnings and complaints by the profession should not result in scapegoating of hardworking ethical doctors. Year: 2008, URI:(archive.php?doc_id=164)
Health Under Labor: Reform or Nationalisation: Will the Labor Government engineer a larger role for public health financing and a smaller role for private health financing? My answer is "Yes, but not for long". ... Health spending is rising inexorably, like a vice grip. One jaw is demand, driven by rapidly rising expectations and an ageing population. The other jaw is the supply effects from new health technologies. Cross-contamination occurs. New health technologies lift expectations. ... The two Howard government Intergenerational reports assess new health technologies as the larger drive of demand, but the contribution from the ageing of the population is accelerating. The demographic outlook is very familiar so I'll race through it. ... * A long term decline in the birthrate, briefly interrupted by the Costello baby boom; * A long term rise in the proportion of the population who are big health consumers - those aged 65 and over - but with a marked acceleration from now until 2020; * A working ages (15-64) population trending to very low growth (PC as shown here) or absolute decline (Access Economics); * All of that resolving as a sharp rise in total crude dependency, now about 2 people of working age for each person aged <15 or 65+, but heading for 1. ... Our health financing system relies on intergenerational tax transfers. The demographic trends suggest that we won't be able to continue increasing those transfers. We may have to reduce them instead. That is more of a political problem than an economic one. Our politicians will be standing in the crossfire, trying to duck and weave between: ... Year: 2008, URI:(archive.php?doc_id=163)
Opening Address Darlinghurst Campus and Medical School of the University of Notre Dame Australia: Opening Address by Prof Julie Quinlivan, Dean School of Medicine, Notre Dame Sydney at the blessing and opening of the Darlinghurst Campus and Medical School of the University of Notre Dame Australia. 13 July 2008 @ 11.00 am @ Sacred Heart Church, Darlinghurst
Year: 2008, URI:(archive.php?doc_id=162)
The Deaf and Doctors: A Shepherd's Two Flocks: It remains my intention to achieve early diagnosis of deafness throughout Australia, accompanied by early intense habilitation, enabling most deaf children to attend a normal education stream, with full integration. Having established Australian treatment as the gold standard, I see no reason why this should not spread to the rest of the world, where even in the wealthiest countries the lot of the deaf child and the deaf adult leaves much to be desired. We are, perhaps understandably, an extraordinarily compliant profession, even naïve. Some would say we are "sitting on our balls ", screaming in pain, and too lazy or too frightened to stand up. It is heartening to see, especially in NSW in the past few weeks, that there are many eminent doctors prepared to speak out on behalf of their patients. May this continue and achieve the desired result -abiding independence of our profession and continuation as a profession, not as a workforce. Year: 2007, URI:(archive.php?doc_id=159)
Turning back tide of errors: To cut the costs, and with little regard for the general wellbeing of the community, it was decided the number of beds should be cut. But there was no health minister with the courage to make the cuts. And so in the '80s the NSW Labor government dreamed up the idea of area health boards to make the cuts on behalf of the minister. These cuts, however, also required the silencing of all adversaries to the plan, and so the NSW Labor government removed nearly all the independent public hospital boards. ... The health bureaucracy burgeoned with countless people who have since spent their working lives attending endless meetings, staring at computer screens and doing precious little else. As a result, much of the funding intended for patient care and for the salaries for nurses and hospital doctors had to be switched to salaries for health bureaucrats. In NSW alone more than $2 billion each year is spent by NSW Health on salaries for people who don't heal anyone. ... The reasonable expectation of young doctors that they will be granted a Medicare provider number as soon as they are qualified has also no doubt caused federal governments to put a limit on entry into university medical faculties, which brings us back to the start. It is quite outrageous that Australia should be importing doctors. Year: 2007, URI:(archive.php?doc_id=158)
Roger Kimball on education & political correctness: "With a few notable exceptions, our most prestigious liberal arts colleges and universities have installed the entire radical menu at the center of their humanities curriculum at both the undergraduate and the graduate levels. Every special interest- women's studies, black studies, gay studies, and the like - and every modish interpretive gambit- deconstruction, post-structuralism, new historicism, and other postmodernist varieties of what the literary critic Frederick Crews aptly dubbed "Left-Eclecticism"-has found a welcome roost in the academy, while the traditional curriculum and modes of intellectual inquiry are excoriated as sexist, racist or just plain reactionary." - [Tenured Radicals. R Kimball (1990)] Year: 2007, URI:(archive.php?doc_id=156)
Book Review: I'm not Crazy, I'm Just a Little Unwell.: Here speaks a patient, not a consumer
Leigh Hatcher is one of Australia's most experienced radio and television journalists. ... His book, "I'm not Crazy, I'm Just a Little Unwell," covers a more personal story. It started on 19th January 1998 at 3.00 pm when ... woke up after a holiday nap to discover that his many years of good health had deserted him. He had become unwell. Year: 2006, URI:(archive.php?doc_id=155)
Questionnaire in Undergraduate Medical Education - ADF Survey Summary - International Data: This data forms a supplement to the Questionnaire in Undergraduate Medical Education published within: An Upheaval in Australian Medical Education - Submission on Australian Medical Education - 15 April 2006 Year: 2006, URI:(archive.php?doc_id=154)
An Upheaval in Australian Medical Education: The last decade has seen what could only be called an upheaval in the way medical students are educated at Australian universities. In 1998, new Deans were appointed to 8 of Australia's 10 medical schools . ... In addition to a rapid expansion in medical student numbers the last decade has also seen changes in the selection process, student population profile, course structure, course content and teaching methods.
Not everyone is happy with the changes. There is a rising chorus of concern across the medical profession that not-so-young doctors are being expected to treat patients to the same standards as their predecessors, without exposure to the necessary amount of training in anatomy (dissection of the human body), physiology, biochemistry and pathology (especially post mortem examination). This criticism could easily be dismissed as the bellow of dinosaurs, were it not so widespread and emanating from medical academics, clinical tutors and practising doctors who have no agenda other than their concern for public safety. This submission provides substantive evidence of that concern and recommendations for improvement.
Our investigation into the justification for some of the major changes in Medical Education lead us to the same conclusion as the Editor of the Australian Medical Journal, Dr Martin B Van Der Weyden, who wrote as an editor's reply in the AMJ of 1 November 2004, "Forbes [Prof. Forbes] concedes that the evidence underpinning these changes to medical education is wanting. And herein lies the rub. Despite continued calls for educational research that matters (and perhaps in keeping with opinions as to how difficult performing such research might be), the medical education community has yet to report solid evidence to support the intentions of these resource-intensive changes. The profession, hardened by the evidence-based movement, expects no less" .
The ADF asserts that there is sufficient evidence for a major rethink of the move away from basic sciences in medical undergraduate curriculum. ... Whilst self directed learning is highly desirable, abandonment of a duty to teach and educate is not. Budgetary pressures may be behind some of the changes in course content and teaching methods rather than the high ideals of education. In particular the disciplines of anatomy and pathology must be re-introduced to undergraduate medical education to ensure safe future medical practice. ...
The Australian Doctors' Fund calls on the Federal Minister for Education, Science and Training to undertake such investigations as is required to assure herself and the Federal Government that Australian medical students are being equipped to adequately meet the clinical needs of the Australian population. An independent national survey of Australian Medical students would be a good starting point. ... The ADF believes there is sufficient evidence that public safety and medical workforce productivity have been unnecessarily damaged by the wholesale adoption of changes that remain untested. Urgent action is required. Year: 2006, URI:(archive.php?doc_id=153)
Towards A More Positive Future For Australian Public Hospitals: 1. Australian tax-payers contribute $18 billion per annum to our Public Hospital system . This equates to approximately $900 for every person in Australia in 2004 or $1,700 for every person without private health insurance or $350,000 for every public hospital bed p.a or $4,535.94 per public hospital separation . Nevertheless the failure of our public hospital system to cope with the demands placed upon it is a major issue in all states and territories of Australia,
2. The Royal Hobart Hospital is indicative of the decline of a once great public institution. The hospital board has been replaced by a state government bureaucracy whose prime purpose is to ration hospital care. Consequently, operating theatre time is regularly rationed and cancelled, elective surgery is regularly cancelled at the last minute aggravating patients and staff, the absolute number of hospital beds has declined over the last 10 years, (albeit official bed numbers and unofficial bed numbers rarely agree), staff overtime is limited or prohibited. In summary, productive capacity is continually disrupted lowering morale and increasing the frustration of those who attempt to work in such a system.
3. Why, when we are spending $18 billion per annum on our public hospital system does it continually fall short of community expectations? The answer is a combination of factors. Year: 2005, URI:(archive.php?doc_id=157)
Australian Doctors' Fund - Response to Productivity Commission position paper (September 2005): The Australian Doctors' Fund (ADF) has considered the Productivity Commission Paper and its draft proposals and submits this response together with recommendations. ... The position paper, Australia's Health Workforce, was released Sept 2005. The paper presents the initial findings of the commissioned study, Health Workforce; which examines matters including the supply of, and demand for, health workforce professionals and proposes solutions to ensure the continued delivery of quality healthcare over the next 10 years. Year: 2005, URI:(archive.php?doc_id=152)
Rethinking Social Insurance - Professor Martin Feldstein: In his article Prof Feldstein explains that:
Western Governments have relied on "social insurance" to protect citizens in the area of disability, unemployment, retirement and health. The escalating costs of these programs are now causing a re-think across the Western world. He has been involved in social insurance for 30 years.
Otto von Bismark introduced social insurance in Prussia in 1881 in an attempt to win support for his conservative government and to fend off the appeal of the social democrats.
In the US, social security and unemployment insurance were enacted nearly 70 years ago with little change today despite substantial changes in economic and technological fundamentals.
Across the western world these costs are rocketing (7% of US GDP 2003) and 37% of US Government outlays. These costs will rise dramatically with population ageing.
Social insurance has undesirable effects. e.g. unemployment benefits increase unemployment, retirement benefits induce early retirement and depress saving, health insurance programs increase medical costs, hence Governments always wanting to redesign social insurance programs.
Year: 2005, URI:(archive.php?doc_id=151)
Medical Schools And Places, Getting The Mix Right Dr. Mukesh Haikerwal - Rescuing Medical Education Conference: It's interesting how the pendulum keeps sort of swinging. People talk about those sorts of things, and there are trends. But I think fundamentally medicine is about not just the science but the art and it's important to get the balance right. But fundamentally we have to keep the science at the outset of our teaching and training because ultimately that's what the public come to us for - for the difference between the scientists and the other practitioners out there. ... Before I talk the specific issue, which is medical school places and getting the mix right, I just want to set the scene. Obviously Bib Birrell has done a lot on that, about the way in which policy is developed and how we've come to a situation of a medical workforce shortage. ... The AMWAC - Australian Medical Workforce Advice Committee - has made great strides in collecting and analysing data. But of course this data has been flawed and certainly analysis has been flawed. The AMA access ecomonic study from three years ago was quite instrumental in showing the workforce shortage amongst general practitioners and that's now the sort of data that AMWAC's using to calculate the new shortfall that we have. And of course there's a shortfall in every speciality, I believe, bar paediatrics. Year: 2005, URI:(archive.php?doc_id=150)
Teaching The Rural/Remote Medical Practitioner - Are They Specialists? Professor Ian Wronski - Rescuing Medical Education Conference: In particular, my interest has actually been the rural remote workforce. Actually, it's quite sizeable. There are 4,000 docs. It's a middle aged workforce, and although most are male, it's increasingly female. There's a lot of private practice there, and it depends a lot on States and how the States are interested in running them. But they do a whole range of things. And very large numbers of them are involved in procedural activity, either accident emergency surgery, obstetrics, anaesthetics, or procedural surgery itself.
Importantly, and I think an important fact in this, is that this is despite the massive assault on small hospitals in Australia. Even given the massive close down of hospitals in small towns in rural Australia over the last 20 years, particularly the last 5 years - lots and lots of these people are proceduralists.
Now the workforce shortages - I have to tell you a bit first - in rural remote areas. It's nice to see it spread everywhere else because now there's a lot more interest in the problems. It's actually not just the medical profession. So I do think, in the discussions about the shortages of medical doctors, there's a whole lot of really interesting points. But actually it's just that medicine collects the data. The nursing shortages are fundamental to problems in hospitals. There are dramatic shortages in allied health, and in pharmacy and in various other areas. So essentially, Australia wide, we have a massive workforce shortage that has extremes in rural areas, but exists now in metropolitan areas, particularly, say, the western suburbs of Melbourne, Sydney and others. Year: 2005, URI:(archive.php?doc_id=149)
Factors Affecting The Outcomes Of Medical Education - Professor Ted Cleary - Rescuing Medical Education Conference: So you need to have a vision for what the practice of medicine is going to be in the future, if you're training people for that. So not only will our students be ready for their internship in those things, but we also are saying that they should practice, and be aware of how to practice ethically; they should be equipped for life long learning and for self care, and we put a large emphasis on that in our personal and professional development strand; and we have decided that destructive competition - competition that leads people to hide books in libraries, that leads people to tear pages out of journals, articles, so that other students can't get at them, which was common in our school when we started this - that should go.
And in the trial course I ran we had no assessment, it was just for interest. A student said, it's got to be assessed if you want the other students to take it seriously - a graduate student told me this. Secondly, it has to be an important part of the passing on, you have to be able to fail. What I said was, I wouldn't assess it, I would ask them to write a reflective journal after the third of the cases that they were dealing with in my form of problem based learning. And the experience of co-operative learning in groups when we introduced that was such that the students, after one year of that, went to the Associate Dean for Student Affairs and asked if all the subjects in the first three years could be non graded pass, because they found the co-operative experience of learning together and not competing with one another for resources was much more effective. Year: 2005, URI:(archive.php?doc_id=148)
The Politicisation Of Specialist Medical Training - Who Should Set The Standards? Professor Donald Sheldon - Rescuing Medical Education Conference: ... This is not just a state or a national issue, it is now an international issue. It was highlighted there that in South America particularly, medical schools are popping up all over the place with very dubious training programmes, and people are coming out with degrees from universities all round the world - moving around the global village and demanding that their qualifications be accepted in other institutions. ... So as well as, I think, today considering the importance of some sort of national integration of standards of undergraduate and post graduate education, we'll have to eventually look internationally as well. ... The other point that popped up this morning, ... this group I had great difficulty coming to terms with. I thought I was a good tutor but no matter how hard I tried I couldn't get any response from them, I couldn't bring them out, I didn't seem to be able to motivate them, and I thought I was losing my touch. ... One of these people was so reticent that I - in desperation - went to the sub-dean and said, look, this individual is not going to make the grade, he's going to need help. I think it's time he was counselled and perhaps redirected into a different career pathway. It was only at that stage that I was informed that the group I had were all fee paying students. They were paying $26,000 a year for their course Year: 2005, URI:(archive.php?doc_id=147)
The Future Of The Medical College Dr Anne Kolbe - Rescuing Medical Education Conference: What does the future hold at least for the medical colleges and vocational education? I think it holds change. Change in meeting community needs and expectations; change in being more objective in what we do; change in working in a more collaborative and partnership and teamwork way; change in opening ourselves even further to public scrutiny and being more transparent in what we do; and change in us being more accountable. ... I think for the colleges it will hold an increasing regulation, and probably rightly so. The AMC has done a wonderful job, and I have to say that I sat on a committee that put in place the accreditation process for vocational medical training. It has been enormously useful in focusing each of the colleges on what their objectives are, and how they are working to achieving those objectives, in just the same way as it focused the universities on their curricula and training pathways. Year: 2005, URI:(archive.php?doc_id=130)
Teaching Clinical Skills In Day Surgery Centres/Units - An Untapped Resource Prof. Guy Maddern - Rescuing Medical Education Conference: The summary then that we would say is we need to diversity our teaching opportunities. I think this is an untapped resource that we should be looking at and I am sure it must apply to other areas in hospital environments, as they change. Day surgery unit, I think, is a great place to cash in on. Consistent learning quality and quantity can be obtained, and I've, sort of, demonstrated this is not a one off, this is now an on-going programme that seems to be delivering consistent results. It's a sustainable activity and it's an expanding activity and we can offer it everywhere. ... So I guess these are the challenges we need to be meeting. ... our rural placement where we're putting these sixth year medical students in four week attachments with one surgeon day in, day out, for a month in rural environments. They're having a fantastic experience and coming back with a lot of the benefits that they get from this process, but of course seeing a much richer complexity of work than you see in a day surgery environment. I think these are the opportunities that are out there and we've just got to learn how to manage them, and at a very low cost. Year: 2005, URI:(archive.php?doc_id=129)
Rescuing Medical Education Conference - Opening. Dr. Bruce Shepherd Chairman, Australian Doctors' Fund: I want to welcome you all here today and congratulate you on having the perspicacity to attend this meeting. When we started off we thought we might get about 30 or 40 people along, and it's very interesting that so many people feel so strongly about medical education. Year: 2005, URI:(archive.php?doc_id=128)
The Registration Of Overseas Trained Medical Practitioners Professor Bob Birrell - Centre for Population & Urban Research, Monash University - Rescuing Medical Education Conference: So the situation we have at the moment then is that, notwithstanding all your concerns about improving medical standards, there are thousands of overseas trained doctors, many from non western medical schools whose standards are uncertain, and what they’ve learned – the relevance of what they’ve learned – may or may not be relevant to Australian patient needs. There is a real problem still to be addressed about this predicament. Year: 2005, URI:(archive.php?doc_id=127)
Newsletter Editorial, March 2005: Rescuing Medical Education, Toward a More Positive Future for Tasmanian Public Hospitals
A Letter From London, ADF news in brief, The Australian High Court says Lawyers can't be sued, Solicitor re-instated by High Court, HIC demanding retrospective payments, Unfreeing the National Health Service, More Bureaucratic Madness in the Land of Hope & Glory, The Rain in Spain, Quotable Quotes
Year: 2005, URI:(archive.php?doc_id=124)
A Surgeon's Perspective On Recent Changes To The Medical Education Curriculum (Dr. Randall Williams - Rescuing Medical Education Conference - Feb 2005)
:
My views can be summarised pretty much as you see up there. Hard sciences and academic excellence are gradually being devalued, in my view. I find that clinical students are keen and enthusiastic, but struggle. I think most - I hope most will overcome their deficiencies but is this right? And I believe the proud traditions of the Adelaide Medical School which was founded in 1885 has produced many fine graduates, including Howard Florey. That tradition I believe to be under threat. ... We've all already heard about the changes to medical education over the ten to fifteen years, the gradual introduction of problem based learning. Anatomy and other basic sciences have, I think, been neglected, and we've heard all about that this morning - the social and behavioural sciences promoted - and I ask is this what the community really needs. Are we producing medical sociologists? What was so wrong with the previous curriculum? Communication skills have become the holy grail of medical medication, and I differentiate communication skills from language skills. I think we must have adequate English. ... patients. Students' basic scientific knowledge, in my view --- they're coming into fourth year now with inadequate basic science knowledge. And clinical tutors such as myself and the postgraduate colleges are having to plug the gaps. Communication skills and those sorts of associated skills are rightly emphasised, I have no problem with that, and possibly we had too little training in the past. But I think we must keep our eye on the ball of scientific training at all times.
Year: 2005, URI:(archive.php?doc_id=123)
The Death Of Autopsy And Oslerian Principles (Professor Phillip Allen - Rescuing Medical Education Conference - Feb 2005): the hospital autopsy rate at Flinders Medical Centre is about 1%. A few coronials increases the rate a little, whereas at the Queen Elisabeth Hospital, which is out of the centre of Adelaide, down the road, the autopsy rate in the hospital is zero. All the autopsies are transported up the Port Road to the Adelaide Hospital where they are performed there, and goodness knows what use that would be to the clinicians who are down at the Queen Elizabeth, they wouldn't have a clue what's going to happen at the autopsy. There's no feedback - absolutely useless. ... But what about this Osler, ... ... How did he build his reputation, ... He concentrated on every case, and those that died, he followed them to the mortuary - ... and he tried to correlate the pathological findings, the macroscopic pathological findings with the body he had seen during life, Year: 2005, URI:(archive.php?doc_id=122)
Are Teaching Hospitals Failing To Teach Acceptable Clinical Skills? - A Student's Perspective (Dror Maor - Rescuing Medical Education Conference - Feb 2005)
: The continuing erosion of quality teaching as a result of escalating service pressure and financial challenges for university departments, hospitals and doctors, has seen both a short and a long term destabilising force for our present and future doctors. What is an even bigger concern is that whilst the availability of tutorial and clinical teaching is decreasing today, the number of medical students around Australia is widely increasing. In our public hospital system, consultant sessions are being reduced, RMO and resident numbers have been cut despite the increasing amount of work that is required from them. Therefore it is evident there are less doctors to teach our students and even the ones who are willing to teach have less time to do so. Year: 2005, URI:(archive.php?doc_id=121)
Emerging Problems With Graduate Medical Education: An Academic Surgical Perspective (Prof John Preston Harris - Rescuing Medical Education Conference 2005): Professor John Preston Harris I'd like to touch a little bit on some themes that have already been addressed this morning, a little bit on the aims of medical education, talk a little bit about trends and outcome, touch on the issue of student assessment, ranking and honours, raise to your attention the implications of age, and proffer a few suggestions. If you look at the opening paragraph in the Australian Medical Council - of the goals and objectives of basics medical education - it encompasses the things that doctors might do and it is basically a pot pourri of all things to all men. Lost somewhere in there is that doctors must be able to care for individual patients by treating illness. And I think one of the things I'd like to come to is that the emphasis on one-on-one doctoring is one of the things that has been diluted in the current process. Year: 2005, URI:(archive.php?doc_id=120)
The Downgrading of Basic Sciences – A Student's Perspective (DR. ANDREW PERRY - Rescuing Medical Education Conference 2005)
: Firstly I want to talk about content; secondly, I'll be talking about feedback; and lastly, I'll be talking about apprenticeship. So, where does the current opinion lie? We've already started to hear from some of the speakers what they think on this topic and I think it's probably fair to say that the room here is split into two camps; that is the academics, those people who are involved in the medical education units and the day to day delivery and implementation of medical education at the universities; and the clinicians, those doctors who may or may not hold dual appointments with the universities, who are responsible for taking these graduates from the university from the classroom, and making sure that they can actually put it into practice in the wards. Year: 2005, URI:(archive.php?doc_id=119)
The Achievement and Rewarding of Excellence Is Not Elitism DR. HELEN BEH
: First of all I'd like to thank the organisers for inviting me to speak at this meeting today. Some of you may feel that you're being a bit slighted by somebody from the Orthopaedic Association being here and not somebody from some other speciality. But let me tell you that I don't think that was the reason that I was invited to speak. In a former life I was the Dean of the Faculty of Science at the University of Sydney at a time when the graduate medical programme was being developed and implemented and so I guess I'd better declare my interest from the start, that I do have a little bit of a bend towards the basic and medical sciences as playing a larger role in medical education than they are doing at the moment.
What I would like to do today is just to review the changes that have taken place in medical education over the past ten or twelve years and then look at the reasons for those changes being implemented. Finally, look at whether the changes have indeed produced better doctors - have been effective or not. And finally, I'd like to put my tuppence worth in as to what I see as the way forward for medical education. (DR. HELEN BEH Chief Executive Officer, Australian Orthopaedic Association)
Year: 2005, URI:(archive.php?doc_id=118)
Towards The Medical Training Super Highway - The AMA Perspective
: From: Rescuing Medical Education Conference (Feb 2005)
The major concern I suppose we all have is around the issue of basic sciences. I am talking particularly anatomy but even it extends to areas of pathology, physiology and biochemistry. These sciences are integral to medicine and medical education. As medicine is an art, it is equally a science. The basic sciences must remain part of our profession, an essential part of medical training. They will always have to be there because they are the basic tools of the trade for every doctor now and into the future.
Year: 2005, URI:(archive.php?doc_id=117)
Opening Address - Rescuing Medical Education Conference DR. BRENDAN NELSON Federal Minister for Education, Science & Training
: There are two things that I will commit myself to doing as the Minister for Education. One is to fund and support some really scientifically rigorous research which examines the progress against a set of criteria which researchers presumably will put to us, comparing graduates from problem based learning degrees with those who come out of more traditional programmes. It is obvious that we need some longitudinal research in this area. Whatever we do we cannot afford to end up with a situation a generation from now that we are in with teaching.
The second is – I think we need to do some work and also support some research which specifically looks at the careers of those who come out of problem based learning versus the more traditional programmes. The attrition rates – I hesitate to say as someone who is not practising medicine although I had to do a bit recently – the attrition rates from medical graduates are I think becoming increasingly higher.
Year: 2005, URI:(archive.php?doc_id=116)
Rescuing Medical Education (Confernece 18 Feb 2005).
: These questions need answers: Is Medical Education in Crisis? - and if so, who and what is responsible? Are we downgrading basic sciences? Are our teaching hospitals failing our medical students? How do we assess overseas trained medical education and those who claim to be competent medical actitioners? What is the acceptable standard?
Why private medical schools? Will more medical schools help or hurt standards?
What is the future of post graduate medical training?
Year: 2005, URI:(archive.php?doc_id=115)
Day Surgery - National and International. From the Past to the Future.
: So much for the past and the present - what about the future? Day Surgery has not yet reached its full potential in Australia - or anywhere else for that matter. Currently, approximately 50% of all operations/procedures are carried out as day surgery although considerable variation from hospital to hospital and surgeon to surgeon still remains! Unquestionably, freestanding day surgery centres are the most patient and cost efficient facilities and it is from these centres that the absolute costs of day surgery practice can be collated. Certainly, the most inefficient model is to have day surgery patients spread throughout hospitals occupying acute beds - so called "day surgery wards" are not much better. In both models, patients are utilising expensive acute beds, equipment and services and this is more so in the public than the private hospital system. The ideal would be to integrate dedicated free functioning day surgery units within hospitals such that they operate the same as a freestanding centre. An obvious and even better model would be to build the freestanding centres on the campus of hospitals. Year: 2005, URI:(archive.php?doc_id=114)
Gammon's Law of Bureaucratic Displacement
A note from Dr Max Gammon with some quotes from Milton Friedman
: bureaucracy is not, I repeat is not synonymous with administration. By bureaucracy I mean a rigid system of human organisation governed by fixed rules and tending to exclude individual initiative. By administration I mean the guidance and facilitation of an enterprise. And this should be the very opposite of bureaucratic. The tragedy of the NHS is that it is an inherently bureaucratic organisation which imposes the bureaucratic mode of operation on all who work in it.
Year: 2005, URI:(archive.php?doc_id=113)
Towards A More Positive Future For Tasmanian Public Hospitals A response to the Richardson Report: This report was commissioned by the Member for Nelson in the Legislative Council, Mr Jim Wilkinson, in response to the Report of the Expert Advisory Group Review into Key Issues for Public Private Hospital Services in Tasmania. 14 May 2004 (the Richardson Report).
The report emphasises the situation confronting the Royal Hobart Hospital as indicative of the plight of Tasmanian and Australian Public Hospitals. Year: 2004, URI:(archive.php?doc_id=112)
Techno-Babble Bingo Game: A recommended past-time for anyone having to deal with the health bureaucracy.
Directions: Keep this table on your desk. Mark off every time you read or hear any of these words in letters, phone conversations or at meetings or conferences.
When you get 5 blocks horizontally, vertically or diagonally, stand up and yell out Techno-Babble Bingo!! JACKPOT Year: 2004, URI:(archive.php?doc_id=111)
Quality in Australian Health Care Study Examined OR Exposed?
: The high profile public release of the QAHCS preliminary information was accompanied by widespread and sensational coverage by the mass media and the medical media. The Minister's abridged version of the QAHCS data was viewed with disquiet, scepticism, frustration and even anger by a medical profession accustomed to the orderly progression of research information through peer review to comprehensive publication. ... The Australian Doctors' Fund has extensively investigated the claims made by the QAHCS. We leave it to the reader to judge for themselves where the truth lies. We can report, but only you can decide. Year: 2003, URI:(archive.php?doc_id=98)
Flexible Spending Accounts
: them. Everyone should be able to choose a health care plan that meets their needs at a price they can afford. When people have good choices, health plans have to compete for their business - which means higher quality and better care. Many Americans enjoy access to good choices in employer-sponsored health care plans, but many others do not have good coverage options or are in danger of losing them. The President proposes to address this problem Year: 2003, URI:(archive.php?doc_id=97)
Position Statements: Medical Indemnity Crisis Society of Australian Surgeons
: The high standard of surgical care presently regarded as the birthright of all Australians cannot be maintained unless long-term solutions are found to the medical indemnity crisis. So far the solutions installed are inadequate. The medical indemnity crisis is substantially due to an increasing culture of litigation in the community generally, and the inappropriate use of medical indemnity via the courts as a de facto form of disability support/welfare. This is a community problem and the financial burden must be laid where it belongs: on the community generally, and not on doctors and their patients through medical indemnity premiums. Year: 2003, URI:(archive.php?doc_id=95)
Submission to Department of Foreign Affairs and Trade on Australia-United States Free Trade Agreement
: Hence, many aspects of Australian health care delivery and finance cannot be morphed to commercial enterprise models without compromising the desired health care outcomes of the community its serves. ... In contrast, the US health care system, maintains a much stronger commercial profile. However, this has proven to have devastating social consequences. ... An Australia - United State Free Trade Agreement (AUS-US FTA) that would allow the commercial strength of the US managed health care system intrude into the Australian community is a serious threat to all Australians, their way of life and, their health. ... In Australia, the public funding of pharmaceutical subsidies, through the Pharmaceutical Benefits Scheme (PBS), is a key component of the Australian health system. It enables the Australian government to bring proven medications to the Australian community at affordable prices. An AUS-US FTA that would foster the dismantling of such a system, or provide for equivalent compensation/subsidy, would be difficult to justify, particularly to those Australians who rely on the $4 billion subsidies for their medications.
Year: 2003, URI:(archive.php?doc_id=86)
Independent Report - Threat to the Survival of Mt Gambier Regional Hospital
: Full Title: An Independent Report on the Threat to the Survival of One of Australia's Most Important Regional Hospitals. Mt Gambier Hospital - South Australia. Stephen Milgate Executive Director Australian Doctors' Fund. ... Uncertainty created by constant budgetary problems has seen a number of administrators come and go, the resignation of some important medical specialists (to date one obstetrician and gynaecologist and the town's only physician), the removal of the town's general practitioners from participation in the hospital as the town's accident and emergency specialists, and an inability to find a satisfactory solution that meets the requirements of the specialist practitioners and the South Australian Government.
Year: 2002, URI:(archive.php?doc_id=85)
Researched Quotes Related to Medical Negligence: All the quotes were abstracted from the ADF paper titled: Proposals for Tort Law Reform - 17 JULY 2002 (the full paper is also available on the ADF website). The quotes are from eminent legal authorities and prominent people in the medical community. Year: 2002, URI:(archive.php?doc_id=83)
Public Hospital Financing - Grasping the Hot Potato: Address to the AMA Public Hospital Financing Forum For the best part of a decade, Australia has been "successful" in restraining national health spending to about 8.5% of GDP while still enjoying access to health services and a quality of care which must rank as close to world best. Among the fruits of this success are: Significant underfunding of MBS fees; Significant underfunding of public hospitals, strong evidence of severe workload pressures and staff morale problems; An imminent haircut for the PBS when there are most likely net health benefits in increasing the proportion of national health spending on pharmaceuticals; Significant underfunding of aged care; Pressures in the private health insurance industry with community disquiet over premium increases and some agitation over the fiscal burden of the rebate; Growing inequity in access to GP services ... Poor remuneration for some health professionals ... The expectations of the Australian community are very high. The sort of technological advance we have seen to date has resulted in a net increase in expectations. ... All the evidence points to an ageing population wanting to consume more and more health services, including services that are more complex and more costly. Year: 2002, URI:(archive.php?doc_id=79)
Submission to the review into Part IV of the Trade Practices Act 1974 (TPA) concerning the impact of the Trade Practitioners Act on medical practitioners working in rural and remote Australia. (Wilkinson Enquiry) : We have to be able to work in co-operative opposition to each other, not in commercial opposition. ... Furthermore, the ADF asserts that no independent professional, not even a chief justice of Australia, can know, let alone comply, with the mountains of guidelines, regulations, edicts, threats, warnings and directives emanating from the growing empire of competition regulators who seek to intervene, interpret and determine all aspects of Australian business, commercial and professional life. ...
Year: 2002, URI:(archive.php?doc_id=72)
Review of: The Quality in Australian Health Care Study
: This article reviews a paper on the Quality in Australian Health Care Study (QAHCS) as published in the Medical Journal of Australia in 1995. The MJA paper follows on from the Harvard analysis of the American Health Care System and the "1994 QAHCS". There are a number of parallels between the Quality in Australian Health Care Study and the Harvard Medical Practice Study, which also drew attention to medical errors. ... Both the Harvard study and the Quality in Australian Health Care study examined medical records to detect evidence of adverse events. By extrapolating from the adverse event analysis both the studies drew extraordinary conclusions concerning the frequency and totality of hospital treatment derived injuries and fatalities. Both of these studies have promoted the view that there are an alarming number of adverse events arising from treatment provided to patients in hospitals. ... The purpose of this review is to analyse the references to "mathematical" and "statistical" techniques in the context of the MJA article. Advanced numerical techniques are frequently used to present data results of studies in a mathematically elaborate formulation. However the formulation need not always establish the correctness of the results presented, the methods used or the validity of any conclusions drawn concerning the system under evaluation. Year: 2002, URI:(archive.php?doc_id=62)
Proposals for Tort Law Reform (a response to litigation and rising
insurance costs): These proposals have been prepared as a response to the increasing concern over litigation and rising insurance costs across the Australian community. 2 The need to reform the laws of negligence It is now recognised by senior members of the Australian Judiciary that the laws concerning negligence require reform. "The deficiencies of the law of negligence have now become very apparent. It favours generosity to the plaintiff at the expense (in many cases) of justice to the defendant. It deters those who provide goods and services to the public from taking risks which might be perfectly reasonable to take." ... "Some judges seem to strive to find a reason for finding in favour of a plaintiff, particularly if the injuries are serious, so that he or she may receive compensation. In the result, damages are sometimes awarded in cases in which a reasonable and informed person would not have thought that the defendant was at fault." ... "We have allowed the tests for negligence to degenerate to such a trivial level that people can be successfully sued for ordinary human activity." "When I say 'we', I mean all levels of adjudication, right up to the High Court."2 The Honourable Justice James Thomas, Judge of the QLD Court of Appeal (1998-2002) Year: 2002, URI:(archive.php?doc_id=36)
Submission to the Trade Practices Act Review - (Dawson Enquiry): The first attempts to establish a Trade Practices Act in Australia in 1962 rejected the US and Canadian model. Subsequently, the 1974 Act used the US antitrust legislation as its model. It is therefore important that the assumptions underlining the development of this legislation be reanalysed to test their current validity. ... to specify what conduct is unlawful rather than rely on generalised terms such as "substantially lessening competition. ... The alleged benefits delivered to Australians by current competition regulation need to be more critically analysed against the cost of growing regulation. ... The ACCC's primary purpose in requesting criminal sanctions for breaches of the Trade Practices Act is to boost its ability to generate adverse publicity and to overcome problems associated with gathering evidence against targets. The ADF believes this is not sufficient justification to introduce criminal sanctions. Year: 2002, URI:(archive.php?doc_id=21)
The Answer to Australia's Medical Indemnity Problem Proposal to Establish the Provision of Medical Services (Limited Liability) Act: Objectives: To ensure that patients are not rejected for treatment because of the risks of litigation which if removed or reduced would result in a medical decision to provide that treatment as required. To reduce the incidence of claims both in quantity and quantum of payout which are the result of misadventure and not the result of acts of serious wilful indifference or serious wilful misconduct on behalf of medical practitioners ie to ensure that MDOs provide effective compensation for patients suffering injuries caused by deliberate and reckless acts of negligence by their medical practitioner. To ensure the provision of an effective and sustainable compensation system for catastrophic claims caused by both negligence and misadventure. To ensure the future provision of medical graduates by providing a reasonable degree of certainty of future reward in return for their personal investment of their time perfecting skills in a medical specialty which currently attracts high levels of patient litigation. To reduce the costs associated with defensive medicine caused by fear of litigation. Year: 2002, URI:(archive.php?doc_id=6)
The Insurance Crisis in Australia
Assessment and Proposals for Reform With Special
Reference to Medical Indemnity: The recent failure of one of Australia's largest medical defence organisations, United Medical Protection (UMP), has highlighted the chronic nature of the insurance crisis in Australia. The cause of the crisis is at least twofold. First, many insurance companies have been caught short by an excessive reliance on increases in stock prices, which did not materialise in time to compensate for underpriced premiums aimed at capturing clients. Second, there has been a significant increase in payouts for personal injury. While the first aspect of the crisis is self-correcting , as some firms go bankrupt (such as HIH) and others raise their premiums, the second aspect has remained unresolved. Medical practitioners, particularly those in 'high-risk' fields such as obstetrics and neurosurgery, and their patients have been especially adversely affected. It is telling that of all common law jurisdictions, only California has more medical negligence suits than Australia. Given the claim that Australia has some of the highest standards of medical care in the world, why has the number of medical negligence cases increased? Changes in the marketing (increased advertising) and pricing (no-win, no-fee) of personal injury legal services probably only provide part of the explanation. It seems likely that the propensity of courts to err on the side of the plaintiff has also played a significant role. It is easy to sympathise with the judge who, faced with a severely injured plaintiff, is moved to award damages against an insured defendant. But the bounds of negligence law in Australia have become so broad that providers of goods and services are unable to foresee many of the circumstances under which they would be liable. Year: 2002, URI:(archive.php?doc_id=5)
Submission to the review into Part IV of the Trade Practices Act 1974 (TPA) concerning the impact of the Trade practitioners Act on medical practitioners working in rural and remote Australia. (Wilkinson Enquiry): The Terms of Reference of the enquiry indicate the Government's concern that the application of the Trade Practices Act should not reduce "the capacity of rural communities to recruit and retain medical practitioners". The Australian Doctors' Fund (ADF) maintains that any enquiry into the application of the Trade Practices Act, and its impact on Australian medical practice, including medical practice in remote and regional Australia, will not be meaningful unless the broader aspects of both competition policy and regulation are examined and appropriate reforms implemented. The ADF supports the free enterprise system in which markets are allowed to work for the benefit of allocating resources based on individual choice and need. The ADF asserts that the application of competition policy in Australia is structurally flawed and that its regulation is biased, predatory and politically motivated. Year: 2001, URI:(archive.php?doc_id=161)
Newsletter Editorial, July 2001 Reform Competition Regulation: Why & How
: This letter launches the Australian Doctors? Fund campaign for reform of competition regulation in health care. ... illustrates just how fundamentally flawed is the whole competition regulatory structure of the Trade Practices Act and its application by the Australian Competition and Consumer Commission ... Recommended Reforms Year: 2001, URI:(archive.php?doc_id=84)
Submission to the Commonwealth Department of Health and Aged Care and Treasury on Informed Financial Consent Discussion Paper: If the Departments proceed with the IFC issue then a few basic principles need to be taken into consideration: 1 Doctors charges fees not gaps. 2 Doctors are entitled to charge their own fees. 3 An independent doctor must always maintain the right to bill his or her patient. 4 Patients have a right to know, where possible and practical, the estimated costs of the Doctor's fees that treat them. 5 Clinical considerations must always override any informed financial consent process. 6 A doctor's obligation to inform patients on fees only extends to his or her own fee. 7 No doctor has a right to fix the fee of another doctor, even though they may be both involved in the treatment of the same patient. 8 Arrangements between patients and third party funders fall outside the responsibility of the treating doctor. Year: 2001, URI:(archive.php?doc_id=73)
'Smartening up or dumbing down?':
A Look Behind the Symptoms, Overprescribing and Reconceptualizing ADHD
: To take a look behind the symptoms of Attention Deficit Hyperactivity Disorder (ADHD) allows us to explore a number of issues: first, 'overprescribing' of medication; second, the notion of 'manufactured epidemic'; third, the process of 'dumbing down' and 'smartening up' the assessment of children's mental health; fourth, discuss the unifying concept of the 'developmental perspective'; fifth, use case studies to introduce new concepts of 'attachment deficit' and 'hyperreactivity'; and sixth, debunk the myth of 'childhood resilience. Finally I suggest 'smartening up' our understanding of ADHD needs inclusion of current advances in attachment theory favouring the new conceptualisation of ADHD as 'Attachment Deficit Hyperreactivity Disorder. Year: 2001, URI:(archive.php?doc_id=4)
The Professional's Guide to Value Pricing: The following quotes are taken from The Professional's Guide to Value Pricing by Ronald J Baker CPA. Some of the quotes in Baker's book are from other authors which have been acknowledged. The book was written for Certified Practising Accountants as a guide to understanding the general principles of business and economics. It is also interesting how Baker marries general business principles with professional accounting practice. Baker favours accountants using the term 'customer' instead of 'client'. He states that the term 'client' is derived from the Latin work cliens, which is a follower, retainer, one who hears his patron. He points out that Walt Disney insisted that his customers be called 'guests' and he referred to his employees as 'cast members'. Year: 2000, URI:(archive.php?doc_id=77)
ADF: Submission to Senate Community Affairs Legislation Committee Health Legislation Amendment (Gap Cover Schemes) Bill 2000: ... The number of Australians paying an excess on their private health insurance, we are informed, is approaching 50% of health funds members. Therefore, almost one in two members will be paying up to $1,000 out of their own pocket to cover the heath fund gap which has been growing at a significant rate. ... Since there is no intention to eliminate the health fund excess (front-end deductibles) it is erroneous and misleading to claim that for a significant number of privately insured patients that gaps will disappear. ... We believe that the Health Legislation Amendment (Gap Cover Schemes) Bill 2000 misses the opportunity to correct some of the flaws that are dogging private health insurance legislation. Sensible amendments along the lines that we have suggested above, together with the repeal of the Lawrence Legislation, are now urgently required to prevent a further deterioration in the value of private health insurance for those Australians who choose to use it. Year: 2000, URI:(archive.php?doc_id=52)
Australian Doctors' Fund Comments on the draft provisions of the Federal Government's proposed Privacy Amendment (Private Sector) Bill: Rather than produce efficiencies, poor privacy protection of health information will generate greater costs and poorer clinical outcomes. ... Furthermore, it is known that the relationship between data and information is logarithmic ie a considerable amount of data must be recorded to generate a small percentage of meaningful information. ... Therefore the justification for discarding traditional privacy protection in order to service the public good by facilitating access to information has not come to grips with the reality that massive amounts of data do not readily produce useful information. ... The Bill does not provide sufficient privacy protection for personal health information ... The Australian Doctors' Fund does not believe that the proposed Privacy Amendment (Private Sector) Bill provides the required level of protection for patients who have traditionally relied doctors and hospitals as custodians of their confidential personal health information. ... The Bill must be interpreted in the light of other developments, particularly e-commerce and e-health ... Although the Bill attempts to restrict the transborder flow of information to countries that have similar privacy principles to Australia, it is not known whether the US is considered as a country which would be a safe recipient of such information. If so there are serious privacy implications. Year: 2000, URI:(archive.php?doc_id=51)
Cannabis for Medicinal Purposes: This paper is written in response to an invitation from the Chair of the Working Party, on the Use of Cannabis for Medicinal Purposes. From a pharmacy perspective, I am doubly surprised that in the year 2000, serious consideration is being given to the medicinal use of any plant in its crude form, instead of a specific alkaloid contained in the plant or synthetic derivatives of it. In addition I am confounded that credibility is being given to the method of administration, namely smoking. No matter where or when the cannabis plant is examined there will always be reservations about its safety especially because of its psychiatric associations. The cannabis plant was a source of some medications in the 19th century but finally disappeared from the US Pharmacopoeia in 1942 as it was used with less and less frequency. Later in 1989 the US Drug Enforcement Agency held an official independent investigation as to whether grounds could be established for marijuana to be used medicinally. In his final judgment the administrator expressed his concern..... Compiled by John Malouf Pharmacist (February 2000). Year: 2000, URI:(archive.php?doc_id=10)
Clinical Indicators for Day Surgery: As the number, variety and complexity of day procedures increase it is clearly important to ensure maintenance (and improvement) in the quality of the care given. To do so the Australian Day Surgery council, assisted by the Australian Council on Healthcare Standards Care Evaluation Program, introduced five generic performance indicators. They were addressed by 240 healthcare organisations in 1997 reflecting the management of over 380 000 patients in day procedure facilities. Year: 2000, URI:(archive.php?doc_id=2)
Beyond the Symptoms of Drug Abuse: The Australian Family Association Conference July 1999 - "Drug Summit - What was not said - Impact on the Family!" ... In essence this paper examined the impact of the policy of harm minimisation (ie a policy which says we must accept the ongoing inevitability of drug abuse and find practical ways, funded by taxpayers, of making drug abuse as safe as possible) and exposed some interesting contradictions over the last ten years by the authors and originators of harm minimisation policy in Australia. ... Some of these contradictions are ... That needle exchange is good because it stops drug users sharing needles (hence claiming that the spread of HIV/AIDS has been prevented by responsible use of needle exchange programs) whilst at the same time admitting that sharing of needles and equipment has accounted for 76% of all people with Hepatitis C. ...In the same vain, advocating widening needle exchange programs whilst previously having called for the discouragement of intravenous use of drugs because of the dangers of cross infection. ... Calling for easier distribution of the supervision of heroin injecting to prevent deaths whilst admitting that the supervision of methadone has been inadequate and has led to the deaths of 240 people between 1990 and 1995, 111 of whom were not on the methadone program. Year: 1999, URI:(archive.php?doc_id=78)
Shortage of Rural Doctors in Australia (and what can we do about it, if anything?): After much deliberation on all aspects of this problem I am firmly of the view that the only way to address the current rural GP shortage is to provide maximum support for rural medical training scholarships and fellowships. We must provide every opportunity for young people with rural backgrounds who have the required intelligence and skill to pursue a medical career. We have to grow our own rural GPs. Rural scholarships have been advocated over the last fifteen years but only recently have they received any form of support. Bright young people from rural areas wanting to pursue medicine, should be and must be given the red carpet treatment both financially and administratively but not so as to lower standards. We have to win them back from business and legal studies. Finally, there is a lot more that can be done in the recruitment of rural GPs however, this will only contribute marginally at best. Year: 1999, URI:(archive.php?doc_id=70)
Medical Gap - A distance between two points: The medical gap is a distance between two points. It can only be bridged if one point is held constant. In other words,
doctors need to voluntarily cap fees. Once that occurs it becomes possible to discuss benefit levels which either bridge the
gap or provide a known differential. The bridge can be built if there is a willingness on both sides to do so. Year: 1999, URI:(archive.php?doc_id=67)
Michael Wooldridge Medical Funding and the Commonwealth Running General Practice: ... The states run the hospitals and they have to do that: the Commonwealth helps with money, but the Commonwealth runs
medicare, it runs general practise, and it has a responsibility for private health insurance. Year: 1999, URI:(archive.php?doc_id=61)
Professional Independence - AMA President's Inauguration 1999: The medical profession in Australia, as in other countries in the developed world, is built on a solid foundation of core principles, These include caring, compassion, an unending search for the truth (which some call evidence), and the pursuit of excellence. As a profession we set the standard of practice based on these core values. Only the profession has the ability to decide what is best practice for our patients, based on experience, insight, and scientific evidence. While we must always be mindful of the realities of cost-effectiveness and health budgets, we must not allow our professional standards to be hijacked by vested interests like governments or private health insurance companies who do not have the same priorities. One of the highest priorities for my presidency will be to guard that professional independence for the sake of our profession and for protection of our patients. ... The crisis facing our current medicopolitical climate has forced us to face the question; "What kind of professional future will we be leaving to our next generations of doctors?" There are serious warning signs. Morale in the profession is at a low ebb. Year: 1999, URI:(archive.php?doc_id=58)
Medical Gaps The Biggest Little Issue on the Table: Quantify the different types of "gap" payments and to show how they rank in importance in household (non-tax) health spending; Explain why the medico-political importance of medical gaps far exceeds their dollar value; Explain why Australia has chosen, thus far, to have medical gap payments; Explain why the gaps are not the biggest problem in health insurance; Discuss the economic and social implications of reducing medical gaps; Discuss the economic and social implications of not reducing them; and Assess the political and practical obstacles to a solution. Year: 1999, URI:(archive.php?doc_id=54)
Getting a Piece of The Action (Lawyers, Bureaucrats, Accountants and Insurance Executives - Managed Care) (a light-hearted approach to serious subjects - webmaster): It is interesting to note also that New Jersey is legendary for the frivolous personal injury claims that the punters and the lawyers get rich on. But there is no effort to stop these activities. If lawyers, bureaucrats, accountants and insurance executives want to practise medicine they should go to medical school. Society today allows them a piece of the action but we need to keep the rule book out of their hands. To me it is like the Pope and contraception. If you aren't playing the game you should not be in control of the rule book. Year: 1999, URI:(archive.php?doc_id=37)
Letter - GP Funding - Dr G Anaf - President, National Association of Practising Psychiatrists: ... GP organisations (on whom we all rely) will have agreed to cut back prescribing, specialist referrals and investigations for financial reward. Decisions will be based on money rather than the interests of individual patients. ... This strategy where GP s are coerced into controlling the purse strings puts them in a conflict of interest that can only benefit Dr Wooldridge, not patients who entrust their care to them. The same policy is failing in the UK, where patients lose by having to accept long waiting lists, lack of immediate attention, and understaffed public hospitals. (Appeared in The Australian, April 1999 ) Year: 1999, URI:(archive.php?doc_id=35)
Health in the Ideal World: Medicine in Valhalla - Maitland Oration - Dr Brendan Nelson: So too health care, as critically important as it is, must be seen in a broader economic, cultural and political context. ... If doctors focus only on the doctor/patient relationship, refusing to participate in decisions of resource allocation - or worse still are desensitised to the agony of the process, then you abrogate your responsibility to those who will miss out. In refusing to participate, doctors are in fact deciding. Resource allocations will then be made by the worst of all possible people - politicians and our public servants. Year: 1999, URI:(archive.php?doc_id=23)
Legal Injecting Places - A Pharmacist's View: I realise that the objective of supplying an alleged "safe" place for injecting is to accommodate the intention of aiding the addict (or experimenter) with the ultimate intention of directing him or her into another place for treatment and also to give help if the person collapses from an overdose. The idea of doing nothing to assist the injector in a back street situation is of course not to be condoned, and nor should it be. The choice is not one or the other. The choice is not one of providing legal injecting places in preference to shooting-up in some lonely back alley. Both are abominations! The choice should be the provision of effective rehabilitation centres. If the addicts have to resort to crime to support their habit, they are not only a risk to themselves but also to others. They should have little choice but to have their addiction broken whether they like it or not. This has nothing to do with civil liberties. To rely on the addicts' freedom to choose as to when the "window of opportunity" exists is not good enough, because many die tragically before this ever eventuates. It must be stressed that the average age of deaths of dependent persons is just over 34 years of age in N.S.W. With this knowledge, can we afford to wait till the chronic user decides he or she wants to quit. There are just too many years to wait, and pitifully too late for many who have waited for this realisation that their addiction could be successfully treated. Year: 1999, URI:(archive.php?doc_id=12)
Legal Injecting Places - A Pharmacist's View: I realise that the objective of supplying an alleged "safe" place for injecting is to accommodate the intention of aiding the addict (or experimenter) with the ultimate intention of directing him or her into another place for treatment and also to give help if the person collapses from an overdose. The idea of doing nothing to assist the injector in a back street situation is of course not to be condoned, and nor should it be. The choice is not one or the other. The choice is not one of providing legal injecting places in preference to shooting-up in some lonely back alley. Both are abominations! The choice should be the provision of effective rehabilitation centres. If the addicts have to resort to crime to support their habit, they are not only a risk to themselves but also to others. They should have little choice but to have their addiction broken whether they like it or not. This has nothing to do with civil liberties. To rely on the addicts' freedom to choose as to when the "window of opportunity" exists is not good enough, because many die tragically before this ever eventuates. It must be stressed that the average age of deaths of dependent persons is just over 34 years of age in N.S.W. With this knowledge, can we afford to wait till the chronic user decides he or she wants to quit. There are just too many years to wait, and pitifully too late for many who have waited for this realisation that their addiction could be successfully treated. Year: 1999, URI:(archive.php?doc_id=11)
Australian Insurance Law Association Seminar Motor Accidents Compensation Act 1999
: There continues to be a very great lack of general community understanding of our motor accident third party system. It is and always has been a somewhat complex and bewildering legal and insurance structure to the vast majority of citizens including many lawyers and most individuals who do sustain injury and loss in motor vehicle accidents. ... The 1999 Act involves further substantial and far-reaching structural change certainly the most significant change since the abolition Transcover and the enactment of the Motor Accidents Act, 1988. ... The introduction of the 10% whole person impairment threshold for non economic loss together with a largely non court administered assessment procedure will be a measure which should impact significantly on claimant behaviour and claim numbers in the short, medium and long term. Year: 1999, URI:(archive.php?doc_id=8)
Clinical Practice Guidelines... Friend or Foe
: Practice guidelines are being introduced throughout medicine, but expectations about their impact on the profession depend on whether one is a clinician, patient, payer, administrator, or politician. Their proponents hope that guidelines will enhance the knowledge, attitudes, and behaviour of practitioners and that they will optimise health outcomes, lower costs, and clarify malpractice decisions. However scientific evidence of these effects is limited. ... Clinicians worry that guidelines will promote "cookbook -medicine", decreasing both their autonomy and income, and increasing medico-legal liability. Year: 1999, URI:(archive.php?doc_id=3)
Australian Doctors' Fund Submission to the Productivity Commission Inquiry into the Impact of Competition Policy Reforms on Rural and Regional Australia: The Australian Doctors' Fund supports the federal government's initiative in calling for a review of National Competition Policy and particularly it impact on rural and regional Australia.
The Australian Doctors' Fund has been an outspoken critic of the application of National Competition Policy primarily, but not solely, on the delivery of health care.
The provision of quality medical treatment and health care is of critical importance to the socio-economic health of any country.
In particular Rural Australia continues to experience deficiencies in the immediate provision of quality health care when compared to metropolitan areas.
The Australian Doctors' Fund accepts the view that there are benefits to the Australian economy from robust competition for the provision of goods and services which act to contain the development of monopolistic forces capable of exploitation , particularly of more vulnerable groups who are unable to exercise reciprocal market power.
The Australian Doctors' Fund contends that the application of National Competition Policy particularly in Rural Australia acts in a way that supports restraint of competition and the elimination of competitors. This is clearly evident in the area of health care. Year: 1998, URI:(archive.php?doc_id=160)
Managed Care and Competition Law Conference - Medico-Legal Society of Queensland & ADF - Brisbane March 1998 (Full Proceedings): ... the passage of the so-called Lawrence Health Legislation which determined that in future all parties involved in private health care in Australia should cease co-operation with each other and engage in open commercial conflict in the interests of the consumer. This conflict is known as the doctrine of contestability. ... This legislation also opened the door for the Trade Practices Commission, now called the Australian Competition & Consumer Commission (ACCC) to make determinations as far as the commercial behaviour of all those involved in private health care is concerned. ... The Lawrence legislation will go down in history as the day the Labor Party embraced US style Managed Health Care. ... The US political backlash from Managed Care strategy has now forced US President Bill Clinton, to legislate: But medical decisions ought to be made by medical doctors, not insurance company accountants. I urge this Congress to reach across the aisle and write into law a Consumer Bill of rights that says this: You have the right to know all your medical options, not just the cheapest. You have the right to choose the doctor you want for the care you need. (Applause). You have the right to emergency room care, wherever and whenever you need it. You have the right to keep your medical records confidential. (LIST OF PAPERS: Lean to the Mean - Trade Practices Act - An Imbalance of Power, - You aint seen nothing yet - The Nuremburg Defence- Quality Care and Professional Standards - Quality Private Health Care in Australia - The American Horror Story) Year: 1998, URI:(archive.php?doc_id=109)
The Question of Collocation - Australian Doctors Fund Collocation Meeting, SYDNEY, 1998 (Full Proceedings): The Question of Collocation, A Growing Trend in the Australian Healthcare Industry, Legal Aspects of Collocation, Problems of Collocation - Experiences from the Past, Collocation - A Working Surgeon's Perspective, The Problem and the Future Problem, The Economics of Hospital Collocation Year: 1998, URI:(archive.php?doc_id=108)
Collocation 'The Problem and the Future Problem' Address by Dr Bruce Shepherd, Chairman, Australian Doctor's Fund
: From: The Question of Collocation Australian Doctors Fund Collocation Meeting Sydney - 20 May 1998 The Question of Collocation Address by Gray Southon PhD, Consultant in Health Management Research and Analysis Year: 1998, URI:(archive.php?doc_id=92)
Collocation - A Working Surgeon's Perspective. Address by Dr Stuart Boland, Former President NSW AMA : From: The Question of Collocation Australian Doctors Fund Collocation Meeting Sydney - 20 May 1998 The Question of Collocation Address by Gray Southon PhD, Consultant in Health Management Research and Analysis Year: 1998, URI:(archive.php?doc_id=91)
Problems of Collocation Experiences from the Past: From: The Question of Collocation Australian Doctors Fund Collocation Meeting Sydney - 20 May 1998 The Question of Collocation Address by Gray Southon PhD, Consultant in Health Management Research and Analysis Year: 1998, URI:(archive.php?doc_id=90)
The Question of Collocation. Address by Gray Southon PhD, Consultant in Health Management Research and Analysis : From: The Question of Collocation Australian Doctors Fund Collocation Meeting Sydney - 20 May 1998 The Question of Collocation Address by Gray Southon PhD, Consultant in Health Management Research and Analysis Year: 1998, URI:(archive.php?doc_id=89)
Collocation A Growing Trend in the Australian Healthcare Industry Address by Ms Anita Ward, Health Reporter for Business Sydney Newspaper
: From: The Question of Collocation Australian Doctors Fund Collocation Meeting Sydney - 20 May 1998 The Question of Collocation Address by Gray Southon PhD, Consultant in Health Management Research and Analysis Year: 1998, URI:(archive.php?doc_id=88)
Collocation Legal Aspects of Collocations. Address by Ms Leah Chick, Senior Associate, Clayton Utz : From: The Question of Collocation Australian Doctors Fund Collocation Meeting Sydney - 20 May 1998 The Question of Collocation Address by Gray Southon PhD, Consultant in Health Management Research and Analysis Year: 1998, URI:(archive.php?doc_id=87)
Simplified Billing Implications for Specialists and Proceduralists: The first issue I am asked to address 'is whether agreements between doctors and hospitals are possible. Let me say firstly that proceduralists are aware of and very anxious to simplify the financial aspects of an episode of hospital care. We believe there are a number of ways in which the present system can be refined and made more patient-friendly. However, there are several wider issues we need to acknowledge before the more subtle aspects of these reforms are debated. ... Government sources have informed us that increases in Medicare rebates would cost very little of the total budget, but such an increase is the carrot they hold. In return for increased rebates they insist on a single-billing agreement with capping of fees. This determination by government to fix surgical fees and institute a bulk-billing system for in-hospital surgical services is one of their top priorities. Year: 1998, URI:(archive.php?doc_id=71)
How Benefit Funds are Killing Private Health: An examination of the problems of Australia's private hospitals and benefit funds, and the need for a better system to deliver cost-effective treatment services with quality outcomes. ... The report analyses the cost-increasing consequences of both government and benefit funds promoting the popular desire to access private health for no copayment. ... though initially attractive in selling medical insurance, is producing consequences only now becoming apparent. The policy is as sensible as offering people access to a 'Car Replacement Fund' (for a standard contribution) and then allowing them to acquire any new car they want with 'no copayment' ... The report analyses the incentives of the present system and its consequences. It identifies two major cost-increasing trends: 1.A transfer of work from low cost treatment facilities, to high cost major private hospitals, 2.A multiplicity of complex administrative activities which have little or no benefit in producing improved treatment outcomes. Year: 1998, URI:(archive.php?doc_id=55)
Newsletter Editorial, September 1998 The Competition Weapon: ...in some cases competition between a few large firms may provide more economic benefit than competition between a large number of small firms. This may occur due to economies of scale and scope, not only in production but also in marketing, technology and, increasingly, in management. National Competition Policy (Report by the Independent Committee of Inquiry August 1993) pg 3. Hilmer in health is about handing us over to the big 'efficient' operators who are better able to do the Government's bidding. All in the name of competition reform. We must not let this happen. Year: 1998, URI:(archive.php?doc_id=50)
Newsletter Editorial, February 1998 Control is still the Agenda: When I first started warning about the control agenda of Government many years ago I was branded by some as confrontationist. I get less hostility these days. Why can't we co-operate rather than confront? The answer is simple. ... There is simply no future for the profession in conceding one inch of its independence to Government, corporations or anyone else ... Our independence is our patients independence from Government and other third parties wanting to get their hands on them. Year: 1998, URI:(archive.php?doc_id=49)
Eleven Unethical Managed Care Practices Every Patient Should Know About: 1. Disregarding personal and medical privacy. 2. Using false advertising. 3. Using deceptive language. 4. Violating traditional scientific ethics. 5. Practicing outside of a professional's area of competence, 6. Creating and intensifying conflicts of interest. 7. Keeping secrets about financial conflicts of interest. 8. Violating informed consent procedures. 9. Using "kickbacks" to keep patients away from specialists. 10. Squandering money entrusted to their care. 11. Disregarding information about harm to patients. ... Year: 1998, URI:(archive.php?doc_id=45)
Liabilities for Doctors in Managed Care Agreements - Managed Care and Competition Law Conference - Medico-Legal Society of Queensland & ADF - Brisbane March 1998: Managed care has been described as an arrangement whereby an organisation assumes responsibility for all necessary health care for an individual in exchange for a fixed payment. Initially, managed care programs in the USA involved development of clear protocols for what symptoms should be present before a patient within a program was admitted to hospital. Protocols have now been developed for out of hospital treatment, including what drugs should be used to treat certain conditions and when allied staff or specialist counsellors should be involved in care. Managed care is a generic term covering a wide range of financing systems. It encompasses: Health Maintenance Organisations (HMOs) with their own hospitals and staff that provide medical care for enrollees. Companies which tender to medical insurance companies to provide medical care for those enrolled. These companies may also tender directly to large employers or directly to governments (for Medicare and Medicaid). The company then negotiates with hospitals doctors and other services to create a network of individual providers. ... The Health Legislation (Private Health Insurance Reform) Amendment Act 1995 (Cth) contains initiatives dealing with potential problems in this area Year: 1998, URI:(archive.php?doc_id=43)
An Imbalance of Power - Australian Competition and Consumer Commission v Australian Doctor Groups: In late 1997, the Australian Competition and Consumer Commission (ACCC) which had replaced the Trade Practices Commission, instituted proceedings against five anaesthetists and the Australian Society of Anaesthetists (ASA) on the grounds of price-fixing for after-hours services at three Sydney hospitals and a threatened boycott of services at one of the hospitals. The ACCC alleged that the anaesthetists agreed to charge $25 for on-call services and that the ASA was knowingly concerned in, or party to, one or more of the arrangements. Dr Wooldridge, in commenting on the anaesthetist's case, has told doctor groups: 'You know, this is the world as it is. You have to work within that. You have to realise that the ACCC is looking after the public benefit, and it is a different world from what it was five years ago.' 83 It certainly is a different world for professionals. But to say that the differences created by the Trade Practices Act, in relation to the provision of medical services, is for the public benefit assumes that the outcome of more open competition results in the provision of better health services. As one commentator concluded: 'Competition policy is seen as a means of promoting efficiency and economic growth. Unrestricted competition does not always promote these ends.' 84 Whilst there should be a removal of the unnecessary barriers to competition, there should not be an abandonment of those barriers which, whilst perhaps appearing to be anti-competitive, are in fact in the public interest. The imbalance is created by the presumptions in the Code that certain activities or barriers are anti-competitive irrelevant of whether in fact there has been a lessening of competition and by the placing of the onus on individual doctors or doctor groups to prove the 'public benefit' for conduct presumed to be anti-competitive. Year: 1998, URI:(archive.php?doc_id=42)
Trade Practices Act - Managed Care and Competition Law Conference - 1998: a plain English version of the relevant provisions of Part IV of the Trade Practices Act ... some of the exceptions without which the plain English statement of the main provisions would not be complete ... The US Federal Trade Commission, unlike our own ACCC, issues advisory opinions on arrangements in the health industry. ... a joint statement on "Enforcement Policy and Analytical Principles Relating to Health Care and Anti-Trust". ... "Rule of Reason". That does not apply in Australia; but it is somewhat akin to our statutory tests for assessing authorisations and dealing with notifications. It attempts to balance harm to competition against any likely efficiencies or benefits in order to see, on balance, whether the arrangement is pro-competition or anti-competitive. ... publication put out by the ACCC, ... contains all kinds of examples of the arrangements that would breach the Act. It threatens huge penalties for breach Year: 1998, URI:(archive.php?doc_id=41)
Managed Care and Competition Law Conference - Medico-Legal Society of Queensland & ADF - Brisbane March 1998 (Table of Contents): ... the passage of the so-called Lawrence Health Legislation which determined that in future all parties involved in private health care in Australia should cease co-operation with each other and engage in open commercial conflict in the interests of the consumer. This conflict is known as the doctrine of contestability. ... This legislation also opened the door for the Trade Practices Commission, now called the Australian Competition & Consumer Commission (ACCC) to make determinations as far as the commercial behaviour of all those involved in private health care is concerned. ... The Lawrence legislation will go down in history as the day the Labor Party embraced US style Managed Health Care. ... The US political backlash from Managed Care strategy has now forced US President Bill Clinton, to legislate: But medical decisions ought to be made by medical doctors, not insurance company accountants. I urge this Congress to reach across the aisle and write into law a Consumer Bill of rights that says this: You have the right to know all your medical options, not just the cheapest. You have the right to choose the doctor you want for the care you need. (Applause). You have the right to emergency room care, wherever and whenever you need it. You have the right to keep your medical records confidential. (LIST OF PAPERS: Lean to the Mean - Trade Practices Act - An Imbalance of Power, - You aint seen nothing yet - The Nuremburg Defence- Quality Care and Professional Standards - Quality Private Health Care in Australia - The American Horror Story) Year: 1998, URI:(archive.php?doc_id=40)
Economics of Hospital Collocation - Australian Doctors Fund Collocation Meeting, SYDNEY, 1998: At first glance, the separate ownership and management would seem to put quite a few obstacles in the way of collocation ever happening and, once it has happened, further obstacles to it ever being made to work successfully. Why so? The collocation of public and private hospitals involves much more than the dictionary meaning of being placed together. There is a purpose in the placement - to extract better use of resources whether they be costly capital or skilled labour. Accordingly, when collocated hospitals have quite separate ownership and management, the entities have to forge a successful partnership if collocation is to achieve those objectives. The placement of public and private hospitals side by side does not achieve the objectives. It opens opportunities that may not be present or may be more limited when the hospitals are physically separate. What has caused the collocation epidemic? The short answer is the economic and financial pressures that have been applied to the hospital sector. Both the public and private sectors have been subject to these economic pressures, some common to both systems and others unique to each. Year: 1998, URI:(archive.php?doc_id=32)
The Question of Collocation - Australian Doctors Fund Collocation Meeting, SYDNEY, 1998 (Table of Contents): The Question of Collocation, A Growing Trend in the Australian Healthcare Industry, Legal Aspects of Collocation, Problems of Collocation - Experiences from the Past, Collocation - A Working Surgeon's Perspective, The Problem and the Future Problem, The Economics of Hospital Collocation Year: 1998, URI:(archive.php?doc_id=31)
Challenging Orthodoxy in Australian Drug Policy: In November 1989 the Australian Doctors' Fund brought together 25 eminent speakers including the current NSW Premier, Bob Carr, to discuss drug policy. This paper ... compares the situation in 1989 to what has happened almost a decade later. ... Despite what Governments may or may not do, the health of our nation is in our hands not theirs. ... In public policy, as in anything else, continuous improvement means constantly questioning our assumptions in the search for truth. Even if this means being labelled heretics. Since 1985 the orthodox public policy stance on drug abuse in Australia ... is: "to minimise the harmful effects of drugs and drug use in Australian society " ... The fact that harm minimisation was very much tied up with the fight against HIV/AIDS and not the fight against drug addiction was made quite transparent Year: 1998, URI:(archive.php?doc_id=13)
Discussion Paper on the Provider Number Legislation (Full Proceedings)
: In the August 1996 Federal Budget, the Commonwealth told junior doctors across Australia they would be denied Medicare provider numbers. A provider number allows a patient to claim a Medicare rebate from their doctor. The power of the provider number in the Australian health system is such that doctors cannot work as GPs without one. Most patients will not pay a fee for service when they are entitled to a rebate through Medicare. The junior doctors would ordinarily have received their provider numbers in January 1997 on completing their hospital intern year. Now they will have to start postgraduate training before they can do any general practice work. ... The provider number bill 'changed the goalposts' for those wanting to work as GPs, says the AMA. In 1995 it took at least seven years to become a GP. In 1996 under the new legislation this had suddenly ballooned to ten years. Year: 1997, URI:(archive.php?doc_id=107)
THE UNEVEN THRUST OF COMPETITION POLICY AS APPLIED TO THE HEALTH SECTOR: My objectives today are to give you my answers to five questions: * What is competition policy? * Is there any economic "foundation" to it? * How is competition policy applied to the health sector? * Does the medical profession need to take it seriously? * What are the implications for doctors in the future? Year: 1997, URI:(archive.php?doc_id=96)
Justice Michael Kirby on Doctors: It is that special dependance - going to the essence of human existence or well-being - that elevates the health care prefessions to a particular nobility. In the age of gene therapy, of computer-aided imaging, of countless pathology tests, there still stands beside the bed or in the surgery the concerned human being with the will to provide relief. ... No computer and no technology that we have yet devised, or can yet imagine, can exhibit that human quality. In the age of cutbacks, of economic rationalisation and of technology we should be constantly reminded - and constantly remind ourselves - of the elements that set the prefessions apart. They include the skill and knowledge that come from training. But more importantly, they require an ultimately selfless caring spirit, an insatiable curiosity, a concern for fellow human beings and a capacity to communicate with them. Year: 1997, URI:(archive.php?doc_id=64)
Newsletter Editorial, October 1997 Survival without Medicare: Every year our profession takes billions of dollars out of the public purse through Medicare. How many of us have retained the concept that our livelihood comes from our patients and not from Government? Hopefully we could survive, as do the alternate therapists, without Medicare. Medicare cannot survive in the long term, yet it has applied a yoke to our professional lives which will never be thrown off unless we fight it. Year: 1997, URI:(archive.php?doc_id=48)
Newsletter Editorial, July 1997 Evidence based Politics: The Australian Doctors' Fund will vigorously expose the political tactics dressed up as being in the "public interest" but really designed to reduce an independent medical profession to a second rate Government department or a compliant client of a Government regulated commercial bureaucracy. ... Dr Wooldridge "...sees himself as a future leader and is not about to let the health portfolio get in his way." With all his reliance on polls our Minister seems to have forgotten leadership and failed to realise that a weathercock never goes anywhere. Year: 1997, URI:(archive.php?doc_id=47)
American spin doctors work hard trying to stop the Managed Health Care Rot: MacStravic goes onto list some of the problems that are giving Managed Health Care a bad name. Some HMOs require consumers to call their gatekeeper physician or plan to receive emergency care, and then deny permission or route them to a distant emergency room. This practice has been the subject of extensive media criticism. Law suits (including a judgement against Kaiser HMO for $45 million), and consumer-protection legislation. ... introduction of …self-care training and manuals to promote self-efficacy and phone-triage services for more-complex concerns. This process is known as self care empowerment. This process …can significantly reduce the demand for emergency care , obviating the necessity for health plans or providers to bar the gates. ... Denying benefits has also caused trouble. Far less frequent, but just as troubling, are cases where life-saving procedures have been denied. Little sympathy is aroused by the assertion that MCOs need to save money, when they are in the spotlight for earning excessive profits and paying outrageous executive salaries and perks. Scandals over the corrupting influence of capitation risk-sharing and utilization/expenditure reduction bonuses have undermined confidence that physicians can make judgments in their patients best interests. Year: 1997, URI:(archive.php?doc_id=44)
Competition Ideology and Health Care in Australia: A talk presented by Mr Stephen Milgate Executive Director, Australian Doctors' Fund. With special reference to national competition policy and the ACCC Year: 1997, URI:(archive.php?doc_id=33)
Discussion Paper on the Provider Number Legislation (Table of contents)
: In the August 1996 Federal Budget, the Commonwealth told junior doctors across Australia they would be denied Medicare provider numbers. A provider number allows a patient to claim a Medicare rebate from their doctor. The power of the provider number in the Australian health system is such that doctors cannot work as GPs without one. Most patients will not pay a fee for service when they are entitled to a rebate through Medicare. The junior doctors would ordinarily have received their provider numbers in January 1997 on completing their hospital intern year. Now they will have to start postgraduate training before they can do any general practice work. ... The provider number bill 'changed the goalposts' for those wanting to work as GPs, says the AMA. In 1995 it took at least seven years to become a GP. In 1996 under the new legislation this had suddenly ballooned to ten years. Year: 1997, URI:(archive.php?doc_id=9)
Microeconomic Reform of the Australian Private Health Insurance Industry A submission by Peter Carrol to the Productivity Commission with reference to the Private Health Insurance Inquiry (Full Proceedings): 1. Require that all mutual insurers make provision for member election of directors, with associated publication of financial statements and holding of general meetings in accordance with normal corporate disciplines. ... 2. Limit the rights of persons with financial interests in the provision of health care services to participate in the governance of health insurers, and prohibit cross ownership arrangements between health insurers and medical/hospital businesses. ... 3. Demutualise and sell Medibank Private. ... 4. Introduce modest copayments and deductibles into Medicare, with appropriate reliefs for social welfare recipients, and allow public hospitals to price their private services on full cost recovery basis. ... 5. Equalise the taxation of mutual and shareholder insurers. ... 6. Direct subsidies for private health insurance into the reinsurance pool. ... 7. Place the prudential supervision of the industry with the Insurance and Superannuation Commission, and replace prescriptive controls on product design, pricing and reserving with appropriate actuarial certifications. ... 8. Abolish the role of the Department of Health and Family Services in regulating private health insurance. ... 9. Retain for a set period, say five years, the provisions of the National Health Act that guarantee access irrespective of health status to private health insurance and require that all members who effect coverage within that period have access to products that guarantee renewability for life. ... 10. Abolish community rating for ancillary insurance. ... 11. Relax community rating for hospital insurance products, commencing with a tolerance of say 15 percent above and below a central community rate. ... 12. Systematically reduce the scope of the reinsurance pool. ... 13. Base the financing of the reinsurance pool on contributions rather than membership... Year: 1996, URI:(archive.php?doc_id=106)
GEOFFREY JAMES ROYAL MEMORIAL LECTURE "Managed Care": Delivered to R.A.C.S. Victorian State Committee 19th October 1996 by DONALD M SHELDON It is a great honour for me to be invited to deliver the Geoffrey James Royal Memorial Lecture. One of the great virtues of our profession is the commitment of surgeons to contribute to the collective knowledge and teaching resources of our esteemed College. Enormous commitment of time and energy by dedicated Fellows ensures that the knowledge, the skills and the ethical standards of surgery are preserved, refined and passed on to junior colleagues in true Hippocratic spirit. Year: 1996, URI:(archive.php?doc_id=93)
Microeconomic Reform of the Australian Private Health Insurance Industry A submission by Peter Carrol to the Productivity Commission with reference to the Private Health Insurance Inquiry (Table of Contents): 1. Require that all mutual insurers make provision for member election of directors, with associated publication of financial statements and holding of general meetings in accordance with normal corporate disciplines. ... 2. Limit the rights of persons with financial interests in the provision of health care services to participate in the governance of health insurers, and prohibit cross ownership arrangements between health insurers and medical/hospital businesses. ... 3. Demutualise and sell Medibank Private. ... 4. Introduce modest copayments and deductibles into Medicare, with appropriate reliefs for social welfare recipients, and allow public hospitals to price their private services on full cost recovery basis. ... 5. Equalise the taxation of mutual and shareholder insurers. ... 6. Direct subsidies for private health insurance into the reinsurance pool. ... 7. Place the prudential supervision of the industry with the Insurance and Superannuation Commission, and replace prescriptive controls on product design, pricing and reserving with appropriate actuarial certifications. ... 8. Abolish the role of the Department of Health and Family Services in regulating private health insurance. ... 9. Retain for a set period, say five years, the provisions of the National Health Act that guarantee access irrespective of health status to private health insurance and require that all members who effect coverage within that period have access to products that guarantee renewability for life. ... 10. Abolish community rating for ancillary insurance. ... 11. Relax community rating for hospital insurance products, commencing with a tolerance of say 15 percent above and below a central community rate. ... 12. Systematically reduce the scope of the reinsurance pool. ... 13. Base the financing of the reinsurance pool on contributions rather than membership... Year: 1996, URI:(archive.php?doc_id=82)
Ethics And Private Practice Agreements An Address to the National Annual Conference of the Royal Australasian College of Surgeons: The whole point of the restrictions on advertising and self-publication are to prevent charlatanism. The complexity of medicine is such that if patients without medical knowledge were to judge quality, the glib and the slick would triumph over the skilled and dedicated. The most reliable standards by which a doctor may be judged are by his or her qualifications. That is the point of the medical College system by which membership is most difficult to attain and the Colleges themselves seek to ensure that standards are maintained at the highest level. ... proposals would have doctors' ranked by health insurance agencies for their "quality service" and thus have them in competition with each other for their reputations. on the lists on the basis of a judgement by a non-medical body, the insurer, as to what constitutes "quality service". Presumably the funds will advertise this list of "quality service providers" to clients - a clear breach of the advertising and publication restrictions. It has always been regarded as unethical for a doctor to claim or to allow to be claimed that be or she in some way provides a better service. This is not consistent with professional medical integrity and the dignity of the profession. Ultimately it would sow mistrust in the whole profession. by implying that some perhaps most practitioners' practices were sub-optimal. Year: 1996, URI:(archive.php?doc_id=53)
Newsletter Editorial, December 1996 - Managed Health Care Trying to make a Rotten Idea Work: Australian Doctors' Fund campaigned vigorously against US style Managed Health Care. Based on market research the Fund placed two full page advertisements in The Australian newspaper and ran two national radio campaigns. Our aim was to demonstrate the medical profession's opposition to signing contracts with Health Funds and to advise what the consequences would be for patients. Year: 1996, URI:(archive.php?doc_id=46)
The Australian Constitution, Medicine and the Law ADF Conference 1996
: CHAIR: DR SHIRLEY PRAGER - Morning Session DR KEITH WOLLARD - Afternoon Session Speakers Notes: Dr. Shirley Prager Dr. Bruce Shepherd The Hon. Daryl Williams AM QC MP Dr. Danuta Mendelson Harry Evans BA (Hons) Sydney Associate Professor Patrick O'Brien Maurice Neil QC Dr. Donald Sheldon Dr. Richard Tjiong Questions Year: 1996, URI:(archive.php?doc_id=7)
Answers to Questions on Notice The Australian Doctors' Fund Limited to the Senate Community Affairs Legislation Committee Inquiry into Health Legislation (Private Health Insurance Reform) Amendment Act 1995 : 1. The ADF, and other critics of the legislation, stress the legislation allows 'US style managed care'. What is the ADF's definition of such care? ... 5. Is the ADF concerned that, if fully operational, Funds may seek to curtail, for example, the ordering of additional confirmatory tests in respect of a diagnosis which may help to protect practitioners against litigation, but are not absolutely clinically necessary? ... 6. Your submission, as well as several others, makes the argument that this legislation could impose a form of 'civil conscription' on doctors in contravention of the 1946 amendment to the Constitution. Could you outline this argument more fully? Given that the legislation does not make purchaser/provider agreements compulsory on practitioners - and the apparent bulk refusal of most doctors to participate confirms lack of compulsion - can the argument be made validly? ... 7. What alternatives does the ADF see as practical and fair in addressing the legislation's stated argument of reducing patient out-of-pocket expenses, while ensuring maximum clinical freedom for doctors? Is the ADF advocating alternatives to private health insurance, such as health savings accounts? Can you outline your suggestions in greater detail? Year: 1995, URI:(archive.php?doc_id=75)
Submission of the Australian Doctors' Fund Limited to the Senate Community Affairs Legislation Committee Inquiry into Health Legislation (Private Health Insurance Reform): It is little wonder that the young and healthy have left private health funds in droves. Young people know that if a medical emergency occurs (which is the most likely scenario in which a young person will require hospital care), they will be taken to the nearest public hospital and the cost of treatment will be covered by Medicare. ... The fact is there is no need and in fact a disincentive for the young and healthy to take out private health insurance. The Funds say that without healthy people taking out private health insurance it is impossible for them to finance a reasonable level of health care to the old and chronically ill and to keep premiums at an affordable level (that is, the defence of community rating). ... It is the ADF's view that this is only part of the problem. Another part of the problem is to do with the private health insurance system itself and the Legislation. In this regard, Roger Kilham of Access Economics had the following to say ... Turning now to the private insurance system, there are also serious problems. Some of these emanate from the over-regulation of private insurance. Others reflect the Federal Government's determination to force the privately insured to carry a very heavy financial burden. ... Year: 1995, URI:(archive.php?doc_id=74)
Limited Liability: "The invention of limited liability made an enormous contribution to the growth of commerce in the modern world. Without it, much of the enterprise which has taken place could not have happened. The risks of failure in the development of new techniques or the opening up of new areas of business are far too large to be taken on the shoulders of individuals, who would be personally responsible for all liabilities which a failed enterprise might accumulate. Thus a corporation whose shareholders' liability is limited to a stated amount, usually the agreed amount of the contribution to the shareholding, enabled the assumption of many risks which otherwise could not have been contemplated." Sir Garfield Barwick. Reflections & Recollections. A Radical Tory. 1995 Year: 1995, URI:(archive.php?doc_id=59)
Professional Independence Surgeons, Professions & Communities. Graham Coupland Lecture: GOVERNMENTS... Once Government decides to intrude into health service delivery, political bias and electoral opportunism become inevitable. Vital determinations may become based on the effectiveness of political activist groups rather than the merit of advice from the informed profession. THE LAWYERS ... Procedural specialists in particular feel vulnerable, Not only are they faced with the awesome responsibility of conducting life threatening operations but must accept as well the hazards of litigation. Performance is often judged against a standard of perfection where even the most meticulous care may be deemed wanting in some respect. ... What quality control programs does the legal profession apply to its judicial performance. Are "judgement indicators" applied to each jurisdiction equivalent to "clinical indicators" which our College now supports to assess surgical performance? I think not. CORPORATIONS ... sees health care as a $38 billion industry ripe for takeover. Many corporation experts perceive surgeons as naive business amateurs who have an altruistic commitment to put principle before profits and patient welfare before financial return. Year: 1995, URI:(archive.php?doc_id=57)
Paying your Health Bills without Private Health Cover: We will glance at a few of the reasons why private health insurance is on the skids. It gives us an insight into why we are now seeing a rash of alternative insurance products and patient strategies. It helps us to explain the key characteristics of these products and strategies. And it helps us to glean an insight into the type and size of the market they might command in the future. ... The private health insurance industry is over-regulated ... For the Federal Government, the policy imperative is that private health insurance complement, supplement and help sustain Medicare. Private health insurance must never upset the public insurance apple cart. Private insurance products must exist within the culture of a benefit for every service, no matter how inefficient this might be. The cards are stacked against competitive front-end deductibles. ... Self-insurance has become an increasingly attractive option for those who see themselves as essentially healthy. In most years, most people in this group will not have an in-hospital episode. If they put aside even part of amount of health insurance premiums, they can be well placed to build quite substantial savings to meet future health needs. In the event of a calamitous health episode, they can always choose to be public patients. Year: 1995, URI:(archive.php?doc_id=56)
Managed Care Presentation By Professor Nancy Dubler: You (Australia) have a health care system that has universal access to care. We (America) have a health care system with 44 million people who are uninsured. ... If they are in a car accident and are brought to an emergency room, clearly they will be treated. But if they have hypertension or diabetes that needs monitoring they will not be monitored and when they show up in kidney failure they will receive a kidney transplant. But the care that they need to prevent that kidney failure is not available. Managed Care has only made it worse. let me begin by sketching out very briefly the bit of history of how we have gotten to where we are which includes the role of the failure of health care reform. ... by the end of the Second World War health insurance had become one of the major benefits of employment. It was recognised in the 50's that there were problems and people who didn't have insurance therefore had restricted access to care, although there was a very a deep tradition of physicians providing care for uninsured persons in county facilities and in fact many physicians gave a day a week of their time in the county facility .... At the same time, Congress was considering and they also passed something called Medicade which was health insurance for the very poor. Year: 1995, URI:(archive.php?doc_id=39)
HEALTH BUREAUCRACY - THE ECONOMIC PERSPECTIVE: Address to the Australian Doctors Fund sponsored conference "HEALTH BUREAUCRACY - CAN WE AFFORD IT?" Canberra, 4 November 1994 By Roger Kilham, Senior Economist, Access Economics Pty Ltd I have set myself three tasks: 1. To seek to establish a framework for considering the issue of health bureaucracy; 2. To offer some observations on the contributions of health economics and health economists; and 3. To offer some thoughts on the financial costs to the community. Year: 1994, URI:(archive.php?doc_id=94)
The Language of the Genes: The message of deafness, for those willing to hear it, is that biology is filled with ambiguity. What seems to be a simple matter turns out, more often than not, to be complex, confused and full of uncertainty. These terms are not often coupled in the public mind with science. Those with a profound attachment to any theory, political, religious or moral, are convinced that every new fact must fit. Scientists, in contrast, often disagree, sometimes about the very fundamentals of their subject. Surely, believers often say, science must therefore have lost the argument. In fact the opposite is true. Conviction kills the search for truth. Science is, above all, the art of the uncertain. All scientific disagreements can, in principle, be settled by observations with which all agree; but every one can be reopened if new evidence suggests that this was premature. Politics and religion, it is abundantly clear, are not like that. Year: 1994, URI:(archive.php?doc_id=66)
Otitis Media in Aboriginal Populations - John Mathews, Amanda Leach, Fiona Douglas, Judith Boswell, Albert Foreman, Terry Nienhuys : From: Conference Proceedings Medical Options for Prevention and Treatment of Otitis Media in Australian Aboriginal Infants Menzies School of Health Research and the Australian Doctors Fund Darwin, Northern Territory Australia 16-18 February 1992 Year: 1992, URI:(archive.php?doc_id=146)
Tympanocentesis in the Management of Acute Suppurative Otitis Media - Robert Berkowitz: From: Conference Proceedings Medical Options for Prevention and Treatment of Otitis Media in Australian Aboriginal Infants Menzies School of Health Research and the Austr
