Medicare and the Public Health Challenge

At a special forum organised by the HSU and other unions, national secretary Craig Thomson spoke of the problems faced by healthworkers due to the decline of Medicare.

Craig Thomson addressing the Medicare Forum

Introduction

Firstly on behalf of all the unions I would like to thank Mark Latham, Julia Gillard and Professor Ian McAuley for coming to today's event.

I know that a lot of you will be disappointed that the new soft, warm and friendly Tony Abbott can't be here......but he did send us this picture of him at work - fixing Medicare - so we don't think he is slacking off.

The Medicare debate has focused a great deal on bulk-billing and cost of GP services but really all parts of the health system are inter-connected and affected by neglect. If you attack the heart the rest of the body is not going to work and the heart of the health system is Medicare

For the Health Services Union, whose membership includes cleaners, kitchen and admin staff, wardspeople, nurses, ambos, aged care workers and allied health professionals, it affects all areas of operation

Emergency

The first area of concern is emergency department. You don't need to be a Rhodes scholar to work out that if you make it harder and much more expensive to see a GP people will turn to the public hospital system.

In NSW emergency departments 1 in 5 attended who could have been dealt with by GP's.
Over 900 people had their ears waxed in last year and I am reliably told that they weren't all from the government frontbench.

Hospitals in Melbourne's western suburbs, estimate that almost one-third of all emergency department patients in those hospitals have medical problems that could be treated by a GP.

Many elderly people don't need to be there either. A year long study of elderly patients admitted to the Prince of Wales Hospital in Sydney found that 79 per cent could have avoided the rush to the emergency department if they had received treatment earlier in a general practice.

Frontline Voices

Listen to what health workers have told me about the effects of the decline in bulk billing has had on their work.

Greg Bruce, Ambulance Paramedic - Sydney

" I really notice the impact of the reduced access to GP's on weekends and after hours. When many people can't access a GP, they call an ambulance instead and this results in a huge spike in our workload and puts enormous pressure on already overcrowded emergency departments. It's very frustrating when you have to by-pass busy hospitals, or wait for hours with a patient on a trolley for an emergency bed to become available.

Judy Richmond is a nurse unit manager. She works in the emergency department of the Mersey Community Hospital in Latrobe in Tasmania.

"In our emergency department we have seen a very significant increase in GP style patients. A lot of them tell us that they can't get into a bulk billing GP so they have no choice but to come to the hospital.
The GP style patients cause a lot of problems for the department and really increase the pressure on the staff. Often they are not happy to wait despite the fact they are have non-urgent conditions and are not a priority."

This may be where you expect the problems to occur in emergency departments, however the impact of the decline in bulk billing GP doctors goes much further.

Diana Asmar is a Pathology Collector. She works in Pathology in the Outpatients Department at The Royal Melbourne Hospital.

"Over the last 2 years I have experienced a drastic increase in patients attending our clinics due to the fact that they could not attend their GP's because it was too expensive"

Chris Martenan - Radiography St Vincent's Melbourne

"Fairly routinely we find that people are opting out of the private system and coming through the public system because of all the associated costs.
We are pretty swamped now but were going to be even more swamped it they take away the bulk billing aspect."

Natasha Markulev, a Mental Health Worker in Victoria

"This means we are left to pick up the pieces as an increasing number of people are admitted to psychiatric hospitals in highly disturbed states. Their mental illness has deteriorated; they are increasingly agitated and this puts staff at risk."

All aspects of a hospitals resources are stretched, either directly or through the diverting of resources away from area's to meet the increased demand, when funding does not match the increase in patient numbers.

Newspoll Research

Unfortunately, Newspoll research recently undertaken for the HSU shows demand is only going to increase as bulk-billing rates fall and the average cost of seeing a GP rises.

When asked which one of the following actions they would be most likely to take if the cost of seeing their local GP increased or their GP stopped bulk-billing:

• 9 per cent said they would go to a public hospital where treatment is free for people with a Medicare card;

• 21 per cent said they would put off going to the doctor if possible;

• 8 per cent said they would go to a different doctor.

Nationally that means over 1.2 million people will choose public hospitals over higher doctor fees each year drowning our public hospital system.

The additional concern is the medical time bomb of 1 in 5 people when ill and sick putting of going to see a doctor when they need to. This will undoubtedly lead to many preventable or manageable illnesses and conditions not getting proper care until they have reached crisis proportions where they are admitted as emergency patients to public hospitals. This undermines the massive push towards preventative medicine.

Reform Needed

Obviously then, restoring the health of the Medicare system is vital to improving our public hospitals. Our union supports genuine financial incentives that will improve the rate of bulk-billing and increase after hours services for all patients not just those in a safety net.

Secondly there needs to be a much greater cooperation between state and national governments on health and this must include the involvement of all those working in the industry.

It was shameful how the Commonwealth held a gun to the head of the states last year to force them, on the most-pressing issue facing the nation, the health funding Agreements, to sign substandard agreements or end up with less money then before. The incompetence of Kay Patterson, who you must agree is the Marcel Marceau of the federal ministry (miming but no speaking or real actions), was a key factor, but it underlined the failure of the states and the Commonwealth over so many years to work together.

Well the days of buck-passing must come to an end.
The problems are national in nature and solutions will only come through cooperation between the states and the commonwealth.

Where there has been cooperation solutions have been found. The trial of a GP clinic at Maitland Hospital saw 10,000 patients treated in the first year and the number of people with minor ailments in the hospital emergency department dropped by 60 per cent.

This is a small but worthwhile initiative that should be supported and expanded into other states.

National Summit

We believe that a national health summit of all health stakeholders is required urgently to start the reform process. This summit should lead to the formation of the National Health reform Commission as a body capable of developing and delivering reforms in the public and private health systems and how much extra funding is provided.

It is essential that in this process, persons who work in the system from the wardspeople, radiographers to nurses, who know the problems and often possible solutions, are given a voice.
Only by having all sectors involved can we truly achieve lasting reforms.

What Do You Think?

Send Craig an email with your views on Medicare and public health

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© 2003 Health Services Union (HSU)
This page: http://www.hsua.org.au/speeches/1075681754_18441.html
Last Modified: Wednesday, 16-Nov-2005 17:19:04 EST