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whitewriterI remember we had a class in university where we had to undertake a task of being a "government" incharge of a health care system.
There was a list of procedures that the population needed; and the number of people requiring each, each year.
It was a simple task - we didn't have statistics on hand regarding which procedures were most effective, or provided the most benefits to those undergoing the treatments; or the statistics on outcomes (which procedures had longest hospital stays or infection risk or reduced quality of life or 5 yr survival rates etc.)
Just looking at the list we had to choose which 50 items we would fund, and in which order of significance. There were more than 50 items on the list meaning that not everything would get a spot for funding.
Like hip replacements. It is decided we can fund say, 100 a year. 200 may be needed. The private system does, say 50. People either die (and therefore don't need the procedure anymore) or go private (then getting off the public wait list). Your place on the list is related to acuity: so the worse you are, the higher u are on the list. Other factors such as quality of life and age may also come into it depending on your doc- who chooses where you belong on that list. Whilst it can sound horrible (dying before the procedure can occur) it becomes something one has to think about when considering our public benefits system as a whole. It's a needs based system. Whilst that jives with my philosophy of you should only ever get what you need when it comes to healthcare:
Medicare in my opinion does one thing very poorly: prevention. It's up to you to be proactive. Everyone can have a free yearly check up/ blood pressure/ blood test allowing for health education/health literacy discussion and or potentially picking up issues before they become a big deal. How many people actually know this and get it? ... not many.
In a (more fully) private system, the insurance company has more incentive to keep you healthy. Medicare doesn't quite care too much about what you, the consumer doesn't care about.
As a group undertaking the task to ration out the procedures we came to a conclusion pretty conclusively and quickly. We were quite young ... and inexperienced in terms of the impact of ill health on a person.
Preventative measures weren't on the list, and you'd think they should be.
So one reality is: if your rich you get what you want whenever you want it. And if your poor you need to wait until you either get worse and therefore get bumped up the list; or die and no longer require the procedure. (although I think overall our wait times are pretty good actually).
The second reality is: if you don't care about yourself, the government won't care either.
In the real world; health outcomes according to postcode are a reality and socioeconomic status puts increasing strain on the public system.
MICH:
I look at ICU and see us spend thousands of dollars on keeping some poor bugger alive; and how much waste there is with our well stocked store rooms- not a dollar sign in sight. We run a full set of bloods up to twice a day.- Thats like $260 (and I've heard some poor excuses for why we ran a full set instead of just what we need to check) Blood gas? sent it to the lab : $60. Do it inhouse its cheaper. But.... the inhouse machine takes more of our time - the real question is, do we need that blood gas? if they're stable?
MSH:
Contrast that to smaller, more community based wards (the postnatal ward for example) and see that each item on the shelf had a cost label on it so we all knew how much each item was worth (even the syringes-- the alcohol wipes).
One nappy per lady, one pad and one blue sheet that's it.
(... And just think of how many blue sheets and adult diapers we could go through in ICU...)
SSH:
Hundreds spent on a birth swing per room.
Thermometers? bring your own (I swear. Downright ridiculous)- some midwives purchase $20 thermometers from chemist warehouse to use at work. Of all things to have purchased for your brand new building, thermometers attached to the wall like at MSH seems to me to be an essential item no one thought about. [or were they being wishful and hoping that every woman would be mobile in labour - making a wall attached thermometer a bad idea?? Was that their thought process? or that we are a small hospital and only take low risk women -- but come on - low socioeconomic status is in and of itself: a risk factor.
Every hospital, it seems, rations differently.
I think about what I'd want, for my own healthcare. If you live in a metropolitan area - you get a choice! If you live rural or regionally; your options are really quite limited.
That's probably why I was happy living close to MSH. It means I fall within their catchment.
All the above being said, I'm a lefty at heart and 100% support medicare and the public system. We'd be a much poorer country without it.
That and mandatory voting.
There was a list of procedures that the population needed; and the number of people requiring each, each year.
It was a simple task - we didn't have statistics on hand regarding which procedures were most effective, or provided the most benefits to those undergoing the treatments; or the statistics on outcomes (which procedures had longest hospital stays or infection risk or reduced quality of life or 5 yr survival rates etc.)
Just looking at the list we had to choose which 50 items we would fund, and in which order of significance. There were more than 50 items on the list meaning that not everything would get a spot for funding.
Like hip replacements. It is decided we can fund say, 100 a year. 200 may be needed. The private system does, say 50. People either die (and therefore don't need the procedure anymore) or go private (then getting off the public wait list). Your place on the list is related to acuity: so the worse you are, the higher u are on the list. Other factors such as quality of life and age may also come into it depending on your doc- who chooses where you belong on that list. Whilst it can sound horrible (dying before the procedure can occur) it becomes something one has to think about when considering our public benefits system as a whole. It's a needs based system. Whilst that jives with my philosophy of you should only ever get what you need when it comes to healthcare:
Medicare in my opinion does one thing very poorly: prevention. It's up to you to be proactive. Everyone can have a free yearly check up/ blood pressure/ blood test allowing for health education/health literacy discussion and or potentially picking up issues before they become a big deal. How many people actually know this and get it? ... not many.
In a (more fully) private system, the insurance company has more incentive to keep you healthy. Medicare doesn't quite care too much about what you, the consumer doesn't care about.
As a group undertaking the task to ration out the procedures we came to a conclusion pretty conclusively and quickly. We were quite young ... and inexperienced in terms of the impact of ill health on a person.
Preventative measures weren't on the list, and you'd think they should be.
So one reality is: if your rich you get what you want whenever you want it. And if your poor you need to wait until you either get worse and therefore get bumped up the list; or die and no longer require the procedure. (although I think overall our wait times are pretty good actually).
The second reality is: if you don't care about yourself, the government won't care either.
In the real world; health outcomes according to postcode are a reality and socioeconomic status puts increasing strain on the public system.
MICH:
I look at ICU and see us spend thousands of dollars on keeping some poor bugger alive; and how much waste there is with our well stocked store rooms- not a dollar sign in sight. We run a full set of bloods up to twice a day.- Thats like $260 (and I've heard some poor excuses for why we ran a full set instead of just what we need to check) Blood gas? sent it to the lab : $60. Do it inhouse its cheaper. But.... the inhouse machine takes more of our time - the real question is, do we need that blood gas? if they're stable?
MSH:
Contrast that to smaller, more community based wards (the postnatal ward for example) and see that each item on the shelf had a cost label on it so we all knew how much each item was worth (even the syringes-- the alcohol wipes).
One nappy per lady, one pad and one blue sheet that's it.
(... And just think of how many blue sheets and adult diapers we could go through in ICU...)
SSH:
Hundreds spent on a birth swing per room.
Thermometers? bring your own (I swear. Downright ridiculous)- some midwives purchase $20 thermometers from chemist warehouse to use at work. Of all things to have purchased for your brand new building, thermometers attached to the wall like at MSH seems to me to be an essential item no one thought about. [or were they being wishful and hoping that every woman would be mobile in labour - making a wall attached thermometer a bad idea?? Was that their thought process? or that we are a small hospital and only take low risk women -- but come on - low socioeconomic status is in and of itself: a risk factor.
Every hospital, it seems, rations differently.
I think about what I'd want, for my own healthcare. If you live in a metropolitan area - you get a choice! If you live rural or regionally; your options are really quite limited.
That's probably why I was happy living close to MSH. It means I fall within their catchment.
All the above being said, I'm a lefty at heart and 100% support medicare and the public system. We'd be a much poorer country without it.
That and mandatory voting.
