It is hard to believe that 2023 is well underway. With the pandemic over in all but name, attention this year will need to switch to all the health issues which never went away and, in many instances, got worse over the past three years.
There is an old adage about putting the horse before the cart. Delivery of medical services occurs within a system. It is fair to say that many of the issues of access to services are a function of the system. This includes the shortage of people, the remuneration offered, time largely wasted on bureaucratic requirements and the inability of practitioners to do what they are trained to do.
Overarching all of this is the Medicare system, which has served Australia well since its introduction in 1984. However, a 40-year-old car, which has never had adequate maintenance, will ultimately break down. Yet, any discussion of reform, let alone actual reform, was effectively destroyed by the ill-fated “Mediscare” campaign of 2016 meaning that the current review will lead to minor tinkering.
Doctors are voting with their feet. It is estimated the GP workforce contracted by 3% in the two years to June 2022. The ability to see a private paediatrician in Perth is negligible. Wait times in other specialties are growing. And to paraphrase Basil Fawlty, don’t mention the public waiting list times.
Still, it could be worse. In the UK, ads are being run encouraging people to think twice before seeking services in the NHS. In some respects, this is not unreasonable. We are all familiar with people presenting with an issue which could easily have been managed at home. However, it says much about the view from above about the capacity of the NHS.
Doctors are voting with their feet. It is estimated the GP workforce contracted by 3% in the two years to June 2022. The ability to see a private paediatrician in Perth is negligible.
Someone made the astute observation that it is no use having a service which is free at point of delivery if you cannot get to the point of delivery. Australia is not at this point, but we are moving in that direction. And yes, the US system is not the answer as it achieves the same result via a different pathway. There is a middle way if we want to find it.
Albert Einstein is claimed to have defined insanity as doing the same thing repeatedly and expecting a different outcome. A system that cannot be touched will ultimately collapse. Our start point must be that we need a system geared to the 21st versus 20th century. We need
new ideas!