Taking charge of your health

By Andrew McKenna

Before the recent Federal election, the government was planning to reform our health system. Here are some incredible statistics about the shape of health in Australia, which may help explain why:

• It’s predicted that the US health system will collapse by 2020 because of unrestrained growth in healthcare costs. Projections for Australia suggest unless we act now, we will face the same in little more than 30 years.
• Iatrogenesis is a public safety crisis, and if we knew what it meant or even how to pronounce it, we’d panic. It’s bigger in Australia than car accidents and suicides put together. And what is it? It’s when you suffer inadvertent adverse effects or complications caused by medical treatment or advice. From a rash on your elbows, only temporary, to outright death, which, unless you’re a Buddhist or a Hindu, can be quite permanent. Not from the disease you’re being treated for, but from the medicines or treatments meant to help you.
• $6 billion out of the $11 billion in the Federal Health Budget is spent on ‘untherapeutic’ GP services. These services are referred to as ‘gatekeeper services’; ie, the GP may do nothing more than refer the patient on somewhere else.
• According to the recent findings of the National Pain Summit, pain management in Australia has an 11 per cent success rate. That means it still hurts about nine times out of ten, no matter what your level of drugs or therapies. And pain management is not getting any better, despite the enormous technology at our disposal.
  ‘The management of pain in Australia is shockingly inadequate,’ the Summit found.
  ‘One in five Australians will suffer chronic pain in their lifetime, yet up to 80% living with this debilitating condition are missing out on treatment that could improve their health and quality of life. An MBF Foundation report conducted by Access Economics has estimated that chronic pain costs the Australian economy $34 billion annually.
• Here’s the clincher: there are three Ps in health care, or at least in the way some practitioners look at it: prediction, prevention and palliative care.
  Prediction is just that: you work at a desk all day, you don’t have ergonomic equipment, your posture is all wrong, looks like you’re headed for a back problem.
  Prevention is simple enough: you work at that desk, but now you need to take a break, do these exercises, get the employer to install this ergonomic equipment, maybe get the occasional massage or other treatment.
  Palliative is, you’ve got a back problem from 20 years of bad posture and sitting at that desk, you need an operation (that’s possibly $20,000-$50,000 out of the health care budget, a couple of years of rehab and, if you’re unlucky, chronic pain for the rest of your life).
  Guess where Australia spends 99 per cent of our health care budget? Predictive? Preventative?
  
• No, Palliative. Less than 1 per cent is spent on prevention and prediction.

In The Australian earlier this year, executive director of the University of Sydney’s Brain & Mind Research Institute, Ian Hickie, wrote: ‘Our state hospitals are anti-competitive and resist innovation. They often lack the capacity, and sometimes the will, to respond to individual patient needs.’

‘Why no action? In reality, the more conservative professional, bureaucratic and business interests in health resist substantive change. Through skilful use of scaremongering, most are pushing hard for retention of our highly protected and dysfunctional local industry. Meanwhile, the deteriorating state of public hospitals, the increasing size of out-of-pocket expenses and the very poor access to quality care for those with chronic diseases, dental problems or mental ill-health are high on any community-rated priority list.

‘A cost rather than a collective social investment’

‘Sadly, health care is portrayed as a cost rather than a collective social investment. In reality, the economy depends on the good health of its citizens, particularly as they age. Finance experts view good health as a key economic investment, just like childhood and youth education, transport and physical infrastructure.’

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Tai chi on the Bund in Shanghai

We are facing a cultural problem as much as anything else: we don’t practise Tai Chi in the parks in the morning en masse like the Chinese, or swim and sauna and beat ourselves with birch fronds like the Finns. Our health is someone else’s problem.

In 2005 the Productivity Commission, the independent agency that is the Government’s principal review and advisory body on micro-economic policy and regulation, conducted a study into issues affecting Australia’s ‘health workforce’, and how they deliver their health services. In 2005 they found Australia was experiencing shortages across a number of professions, and because the demand for healthcare would increase as the labour market tightened, they recommended that new models of healthcare would be needed.

Treasurer of AHPA, Dr Simon Floreani

The Chiropractors Association of Australia has pointed out that if the Government were to take the Productivity Commission’s recommendation seriously, then a ‘paradigm shift’ is required in Australian healthcare.

‘Why not spend money on educating people on how to eat properly rather than build another expensive hospital?’ says chiropractor Dr Simon Floreani, Treasurer of AHPA, Allied Health Professions Australia.

Why not, he says, put the guardrails at the top of the cliff rather than the ambulance at the bottom?

‘It’s like a fire alarm going off and we’re not investigating it. Here health is outsourced. You can outsource your health, with no responsibility to the consumer, and it becomes someone else’s problem. Or you’re led to believe it’s someone else’s problem.

‘How can a GP be expected to step into your life and renavigate your health? It can truly only be addressed by you having a relationship with your healthcare practitioner.’

Dr Floreani says patients – us – are now in the middle and the practitioners are around us.

‘It’s a change from “I’ll tell you what to do”, to “how can I help you?” It’s patient-centred care. We’ve come from two generations where you just did whatever the doctor told you to do. You need to be in control and not just hand over your health.

‘The government has funded a project into facilitating a team collaborative approach, particularly for chronic disease management. They have worked on developing pathways for practitioners to talk to one another.’

And already these days before you go to the GP you’ve most likely googled your symptoms and have a fair idea what’s going on, as well as treatment and prognosis. Floreani says this only for the good.

And yet, he believes the ‘industrialisation’ of medicine has caused a lot of consumer disempowerment. When the health chips are down and we’re faced with a bewildering array of tests and machines, of course many of us lose our way and can’t make a decision for our own good.

The Labor Government recognised the need for major reform and initiated that process. Until the Caretaker period, it had begun reviewing Medicare, under the appropriately enough named Medicare Review.

The Third Pillar of health

AHPA (Allied Health Professionals Association) refers to itself as the ‘third pillar of Australia’s hospital and health services, along with doctors and nurses’. Should Nicola Roxon be Health Minister when the mess in Canberra is sorted out, Dr Floreani believes significant funding will be directed to strengthen the role of that third pillar.

‘Allied health’ is a term we may become more familiar with, especially if the AHPA has its way. AHPA represents 17-18 different professions, including such modalities as psychology, audiology, chiropractic, OT and physiotherapy.

AHPA closely watched the Federal Government’s moves to reform the health system, and supported the general thrust of the reforms agreed to by the Council of Australian Governments earlier this year.

You will not get adequate services

‘The Health Budget is in big trouble,’ Floreani said.

And the situation is getting worse. Here’s Ian Hickie again writing in The Australian: ‘Even though we are very reluctant to admit it in this lucky country, the reality is if you have less money and you have a chronic illness such as diabetes or heart failure, dementia, a significant dental problem or a mental illness, you will not get adequate services.

‘Sadly, a range of interesting financial alternatives is not on the table for discussion.’

OW THAT HURTS: ‘Chronic disease is becoming a massive burden on the health care budget,’ Dr Floreani says. At the National Pain Summit, it was recognised that pain management in Australia has an 11 per cent success rate. That means it still hurts nine times out of ten, no matter your level of drugs or therapies. Pain management has gotten worse, and pain creates a massive drug dependency. It creates psychoses and psychological problems, especially chronic pain. ‘The management of pain is atrocious,’ Floreani says. Among the recommendations from the summit were for a team collaborative approach. If health care were more consumer driven, the consumer could advise the doctor to talk to other practitioners. ‘Empower yourself to be a better consumer,’ says Floreani. ‘Find people that will serve you in your own continuum, rather than just getting what you’re given.'

Rather than a major or an even interesting financial reorganisation, Dr Floreani believes we could address our health problems and shortages through recognising that ‘third pillar’.

The problems are worldwide – at least in the industrialised world – but we’re a small country and he believes we could lead the way with smart reform.

‘We have a gutsy Minister in Nicola Roxon in her demand for health reform. She understands how allied health can be involved.

‘The recent Intergenerational Report indicates that the Federal Budget is headed for deficit -massively in debt – and the major part of that is health care.

‘The financial issues and the statistical issues are coming together, and there’s a government with enough interest in it to say yes we’re making the changes, and we also have technologically savvy consumers. I think that’s wholesome. It’s a very exciting time for health reform.’

Ian Hickie again:

‘We need substantive change. Tinkering at the edges will have no long-term effect … It is predicted that the US health system will collapse by 2020 due to the unrestrained growth in healthcare costs. Projections for Australia suggest unless we act now we will face the same calamity in the period after 2040.’