Posts filed under 'National Registration'
The practice of medicine is essentially an interaction between sick people who seek assistance and their medical practitioners. In many countries this activity has been deliberately restricted by totalitarian regimes. China has to a large extent chosen to ignore scientific medicine and has instead promoted traditional Chinese medicine. This style of health care relies heavily on herbal remedies and acupuncture. Not surprisingly, national expenditure on health care in that country is minute compared to that of the Western world where up to 14% of G.N.P. is allocated to health care. Our communities have come to expect and demand the latest and greatest health care services. The British National Health Service is the biggest employer in the E.E.C. Health care in Australia has become big business with $38 billion or 8.5% of G.N.P. being spent on health services.
With such vast sums of money being spent on health care, commercial interests are seeking to intervene in the basic doctor/patient interface and to secure for their shareholders a slice of the health care cake. Drug companies, instrument makers, hospital conglomerates, health economists and health funds are all jostling for a market share in what is now called the health care industry.
Politicians correctly perceive enormous electoral opportunities by involving themselves in the provision of health services. Screening programs for politically sensitive diseases have secured many votes. Health administrators are quick to claim the kudos for advancement of medical knowledge and for life saving operations.
Health care administration has become the growth industry of the modern epoch. Fourteen hundred (to be reduced to 1,200) medical graduates are produced nationally each year whilst 8,000 graduates in health administration continue to be trained. 25% of all health care costs in Australia are spent on administration.
One of our problems is of our own making. Scientific medicine is now so sophisticated, so refined and so reliable that the surgeon of today can offer relief of suffering and complete cure of previously fatal diseases with a safety and certainty not dreamed of two generations ago. Unlike some professions and commercial endeavours, medical practice is a very successful growth industry. Surgical care is the most spectacular, glamorous and potentially remunerative of all disciplines.
The practice of medicine is essentially an interaction between sick people who seek assistance and their medical practitioners. In many countries this activity has been deliberately restricted by totalitarian regimes. China has to a large extent chosen to ignore scientific medicine and has instead promoted traditional Chinese medicine. This style of health care relies heavily on herbal remedies and acupuncture. Not surprisingly, national expenditure on health care in that country is minute compared to that of the Western world where up to 14% of G.N.P. is allocated to health care. Our communities have come to expect and demand the latest and greatest health care services. The British National Health Service is the biggest employer in the E.E.C. Health care in Australia has become big business with $38 billion or 8.5% of G.N.P. being spent on health services.
With such vast sums of money being spent on health care, commercial interests are seeking to intervene in the basic doctor/patient interface and to secure for their shareholders a slice of the health care cake. Drug companies, instrument makers, hospital conglomerates, health economists and health funds are all jostling for a market share in what is now called the health care industry.
Politicians correctly perceive enormous electoral opportunities by involving themselves in the provision of health services. Screening programs for politically sensitive diseases have secured many votes. Health administrators are quick to claim the kudos for advancement of medical knowledge and for life saving operations.
Health care administration has become the growth industry of the modern epoch. Fourteen hundred (to be reduced to 1,200) medical graduates are produced nationally each year whilst 8,000 graduates in health administration continue to be trained. 25% of all health care costs in Australia are spent on administration.
One of our problems is of our own making. Scientific medicine is now so sophisticated, so refined and so reliable that the surgeon of today can offer relief of suffering and complete cure of previously fatal diseases with a safety and certainty not dreamed of two generations ago. Unlike some professions and commercial endeavours, medical practice is a very successful growth industry. Surgical care is the most spectacular, glamorous and potentially remunerative of all disciplines.
Continue Reading March 4th, 2009
The condition of the American medical profession at the close of the Civil War was, in almost every particular, significantly different from that which obtains today. The profession was, throughout the country, unlicensed and anyone who had the inclination to set himself up as a physician could do so, the exigencies of the market alone determining who would prove successful in the field and who not. Medical schools abounded, the great bulk of which were privately owned and operated and the prospective student could gain admission to even the best of them without great difficulty. With free entry into the profession possible and education in medicine cheap and readily available, large numbers of men entered practice. Indeed in 1860 the census data indicate that the country possessed over 55,000 physicians, or 175 per 100,000 population, almost certainly the highest number of doctors per capita of any nation in the world.
Continue Reading March 4th, 2009
Currently we are passing through a historic juncture in the development of health care in Australia. The government, bureaucrats, regulators, medical profession, and the general population are increasingly alarmed at the prospect of the introduction of the American styled “managed care” to replace the Australian health care system. Considerable debate is currently focused on the clinical, economic and ethical advantages and disadvantages posed by the introduction of “managed care”.
On balance, the American experience of “managed care” has been judged most unfavourably on all three counts. This should not be surprising given that “managed care” is a slogan for “mismanaged care”, an interference in the doctor-patient relationship by non-medical economists.
The unfavourable attitude to “managed care” has highlighted two emerging areas of concern in America which ’seem quite likely to bring about legislative initiatives, consumer concerns about the quality of care and doubts over the long-term cost saving’ (Budetti, 1997, p 197). This paper will focus on the impact of the American pseudoethical system of “managed care” (Halasz, 1997) on the ethical principle of autonomy as it relates to the doctor-patient relationship.
Continue Reading March 3rd, 2009
The Fear of Reduced Autonomy
In modern times the professions, including and especially medicine, are practiced in a turbulent and challenging environment. Faced with the globalization of capitalism, ‘capitation’, ‘managed care’, ‘devolved budgets’, and much more, how should the medical profession respond? For many in the profession these are times of great trepidation. On one view – according to Professor Stephen Duckett of La Trobe University – ‘in reality the fear of the medical profession is one of reduced autonomy’ (Duckett, 1997:89). Perhaps so. But there are at least two very different ways of understanding that apparent ‘fear of reduced autonomy’.
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It is important to make one final yet crucial point. Indeed it is a further matter for deep disquiet about the impact of managerialism on medicine. The elevation of ‘efficiency’ and ‘choice’ (for consumers) to the status of goals or ends is characteristic of the modern managerial agenda. But efficiency is not a goal: efficiency is a means to an end, not an end in itself. Efficiency is not to be pursued for itself, but, rather, is concerned with the way we go about securing our ends. Eichmann was a good manager because he ran an efficient, cost-effective (albeit one-way) travel agency for the Nazi death camps – no questions asked. We must therefore excavate the managerial agenda, going behind talk of ‘efficiency’ and ‘choice’ to expose the real goals hidden behind the rhetoric of managed care. Duckett steers us in the right direction, towards the really big players in the health arena – government and other payers (e.g. corporations) – who have come increasingly to dominate the field. For what we must insist on is that these big players, who are the big payers, the state and the corporations, make the connections between the values of the sanctity of human life and the care of the sick and suffering, on the one hand and on the other, the managerial aims of efficiency and choice.
Whether the medical profession has squandered its resources of public faith in its altruism or not remains to be seen. Yet there is no other group in society who can speak so powerfully on behalf of the sick and suffering as the medical profession. The future is grim. But there are moral outcomes at stake, perhaps even worth dying for, as Dr Shepherd might say.
Continue Reading March 3rd, 2009
15/02/2009 - 12:00pm
The Directors of two of Australia’s leading centres on medical ethics are gravely
concerned that a new draft code of conduct for doctors put forward by the Australian
Medical Council, and that would be backed up by the force of law, is flawed.
The draft code is likely to be adopted by the proposed new National Medical Board in
setting standards for, and in regulating, medical practice, including the assessment of
complaints and allegations of unprofessional conduct against doctors.
In an article in the current edition of the Medical Journal of Australia, Professor Paul
Komesaroff, Director of Monash University’s Centre for Ethics in Medicine and Society,
and Associate Professor Ian Kerridge, Director of Sydney University’s Centre for Values,
Ethics and the Law in medicine, say that the draft code, a set of quasi-legal rules
assembled from a collection of other codes and guidelines from around the world, might
appear benign.
However, the Code was likely to be counterproductive for four main reasons:
Continue Reading February 18th, 2009
Good Medical Practice:
A Draft Code of Professional Conduct
Developed by a working party of the Australian Medical Council
on behalf of
the Medical Boards of the Australian States and Territories
Consultation document
August 2008
Consultation period 27 August 2008 to 28 November 2008
Continue Reading February 13th, 2009
NATIONAL REGISTRATION AND ACCREDITATION SCHEME
FOR THE HEALTH PROFESSIONS
CONSULTATION PAPER
Proposed Registration Arrangements
Issued by the Practitioner Regulation Subcommittee
Health Workforce Principal Committee
Australian Health Ministers’ Advisory Council
19 September 2008
Continue Reading February 13th, 2009
This submission is written in response to the impact of the COAG IGA National Registration & Accreditation Scheme in respect of the Australian medical profession although the points may impact on other areas, the submission does not claim to speak outside of the medical profession.
The Australian medical profession is a national asset. It stands to reason that any substantial intervention to the way it functions as an independent profession must be justified in the public interest.
The proposals put forward by COAG do not meet such a test. They arise from the writings of Professor Stephen Duckett, who claims that current pressures on the delivery of Australian health care can be largely attributed to a lack of central planning by government. Where is the evidence to support this claim? The COAG-IGA proposal is a house built on sand - a claim without evidence.
Prof Duckett’s work can be seen in the COAG-sponsored Productivity Commission Report, which made numerous recommendations for increased central planning functions over the medical workforce, but failed to provide any substantive evidence that such changes would improve workforce productivity (it stated it could not measure productivity) or lower health costs. The lack of cost/benefit analysis for such widespread proposals is breathtaking.
Furthermore, the COAG model sees the introduction of intermediaries between the doctor and the patient, in the form of allied healthcare professionals with wider scopes of practice. Such policies would introduce into Australia a two-tiered health system, where direct access to a doctor is substituted by the use of lesser-trained gatekeepers (patient assessors), particularly for those with limited ability to pay.
Continue Reading February 13th, 2009
From: ASA - Email Newsletter (December 2008)
Each day many of my colleagues’ – both anaesthetic and nonanaesthetic – ask me these questions:
* “So what is the problem with national registration?”
* “Why are the ASA, the AMA and other professional associations so concerned?”
* “Surely we want to be able to move from state to state easily?”
Continue Reading January 23rd, 2009
Australian Doctor - 16-Jan-2009
By Paul Smith
GROWING fears of political meddling in medical education and standards is putting the medical profession on a collision course with State and Federal Governments.
Continue Reading January 23rd, 2009