Saturday, November 28, 2009


Three current articles below

Only the market can make health system person-centred

Vouchers needed, says Dr Jeremy Sammut

According to the NHHRC, the most important health reform recommendations in the Bennett Report will make the health system person-centred by reorienting the system around stronger primary care. This will supposedly allow health consumers to have access to the services they need rather than only have access to the current mix of ‘hospital-centric’ health services that governments want to offer.

The idea of a person-centred rather than government-centred health system is borrowed from the market-based principles associated internationally with the consumer-directed health care movement. The aim of consumer-directed health care is to reform the old-fashioned ‘command-and-control’ arrangements that limit choice and prevent competition in the government sector of the health system.

Right now, the type, amount and mix of taxpayer-funded health services that are or are not provided to Australians are determined by federal and state governments, whose crucial yet often imperfect policy decisions frequently overlook the actual needs of patients.

Health departments allocate taxpayer subsidies in the form of population-based, capped global budgets to public hospitals and community health services, which are expected to deliver an unquantified and indeterminate amount of health services to the community. For consumers, this is well described as a ‘take what you’re given’ system.

Consumer-directed health care would improve the responsiveness of hospital and other health services by the application of quasi-market mechanisms. The key reform is to make funding flexible, responsive, and far more accountable. The taxpayer subsidy should be tied directly to the delivery of services and only be paid at the point at which each occasion of care is provided.

Funding should follow patients by means of a taxpayer-funded voucher, and patients, subject to clinical referral, should be allowed to purchase appropriate services from competing public or private providers.

In the long run, empowering consumers and tying funding to patients based on clinical need and choice of competing providers would reduce costs, while increasing access, quality, productivity, and allocative efficiency. Most importantly, governments would no longer centrally plan the type, amount and mix of health services as the supply would be set by the actual health needs of individual patients.

Market-based structural reform that promoted the efficient use of scarce resources would therefore establish a truly person-centred health system.

The above is a press release from the Centre for Independent Studies, dated November 27. Enquiries to Snail mail: PO Box 92, St Leonards, NSW, Australia 1590.

Government health agency gets criticism of its incompetence censored

Another botched and dangerous attempt at computerization

The University of Sydney removed from its website an extremely critical essay about a new multimillion-dollar emergency department IT system after pressure from the NSW Health Department. Doctors, nurses and administrators at four area health services heavily criticised the system - which tracks patients - as posing an "unacceptably high risk" to patient safety because it was so slow, cumbersome and inefficient. Some hospitals have boycotted Cerner FirstNet and reverted to paper to record clinical notes because it is too difficult and too time-consuming to retrieve critical patient information from the system, the essay said. "In a number of cases we know senior clinicians have shut down the use of FirstNet within a few days of it coming online," it said.

This flies in the face of the recommendation last year from Peter Garling's inquiry into public hospitals for full electronic medical records to improve efficiency and patient safety.

The essay, by a medical IT professor, Jon Patrick, said several hospitals also reported it "doubled the delay" before emergency patients were first seen by a clinician. He also said the Cerner contract proposal suggested it was giving a "cheap price" on the proviso of a "speedy finalisation of the contract" which left NSW Health with such an "incredibly tight schedule" it stymied proper clinical consultation.

The essay was published late last month but NSW Health asked that it be removed, Professor Patrick said on his website. The university then published it again two weeks later. "I have been able to establish confidently that NSW Health phoned my head of department and asked him to remove the article without giving a specific complaint," Professor Patrick wrote on November 5. On Wednesday, he wrote: "The university has affirmed my right to publish my critical essay and the attempt to censor me has been mitigated."

The Deputy Director-General of NSW Health, Tim Smyth, told the Herald that the acting chief information officer, Craig Smith, contacted the university about the essay but did not ask for it to be removed. "That's entirely a matter for the university but my personal view having read the article is that I don't believe it's balanced, it's certainly not accurate and it certainly misrepresents reality," Dr Smyth said. The assertion of a cut-price deal was "just wrong", he said.

One doctor said: "I prefer looking at a paper result than the counter-intuitive waste of my time trolling [sic] through the system." Another said: "Every single user *hates* it with a passion … ENTERING the data is a pure nightmare."

Cerner FirstNet follows emergency patients and includes test results and statistics such as beds available. It is part of a massive three-year electronic records project due by June.

Professor Patrick has worked on IT projects with permission from area health services but was not asked to assess Cerner FirstNet.


Grim treatment of patients in government mental hospitals in Western Australia

A psychiatric patient claims to have been raped while in the care of WA's mental health system, according to a new report. The disturbing claim was contained in a report by the WA Council of Official Visitors, which includes allegations of serious breaches of mental health patients’ rights.

The patient claimed to have raped by a guest of another resident while staying at a mental health hostel. The Council of Official Visitors supported the rape allegation and the claim led to an upgrade of security at the hostel. The alleged victim has since left the hostel.

Other claims of neglect include allegations that some patients were being tied down and forced to spend the night soaked in their own urine. Food served in mental health facilities was often described as poor by patients. Meanwhile, parents of patients have complained that they are searched before they can see their children as if entering a jail. An elderly female patient said she was not allowed to keep personal belongings like a toothbrush. Some patients had been dumped in maximum security wards for up to six years when they should be cared for in the community.

According to the council, life for patients in these wards was grim. “They live in an artificial locked ward environment, not receiving the type of care which would best enhance their recovery potential,” the report said. “They don’t get to choose when to eat, how much coffee to drink, who to associate with, or if and when to smoke.”

Council of Official Visitors head Debora Colvin said some mental health patients were not given access to the toilet while they are "secured" in a locked ward. Patients are still being forced to travel in the back of a “paddy wagon” for long distances without a break. The report said there were major concerns that second opinions weren't being properly conducted throughout the WA mental health system.

Mental Health Minister Graham Jacobs said there was some good news in the report. Dr Jacobs said it was the first time in 11 years there was a 20 per cent reduction in the number of people who contacted the council to make a complaint. “The natural assumption is we’re doing a little better,” he said.

Dr Jacobs said there was a need for more community supported accommodation for people with a mental illness, which his Government was establishing. “Instead of large cluster homes on hospital grounds we want small home-like facilities in the community,” he said. Dr Jacobs said there had been improvements to secure wards at hospitals in Graylands and Joondalup.

A Mental Health Commissioner is also expected to appointed early next year for WA.


More stockmarket hotshots playing with other people's money -- and losing

St Vincent's hospital board loses $24m on junk bonds. The Sydney Anglican diocese had a similar meltdown over the same period

THE board of one of Sydney's biggest hospitals is under fire after losing more than $24 million on the sharemarket using money taken from trust funds containing public donations and federal government research grants. Senior doctors at St Vincent's Hospital have called for an independent inquiry after discovering about $80 million, some of which was earmarked for new equipment, research projects, education and salaries, was used to buy high-risk bonds, the same kind responsible for triggering the global financial crisis last year in the United States.

Doctors are furious because they say research projects, which had already been granted funding, might now be cancelled and donors will be upset to learn their money has been lost.

The National Health and Medical Research Council forbids its grants being used for any purpose other than the approved project and demands funds be returned if the research is not carried out, but a spokesman for the hospital said its financial and legal advice "doesn't support that argument". He declined to outline how much research money had been used to buy bonds, but denied claims by doctors that the hospital had been attempting to fill an $11 million hole in its budget. "Any idea that millions of dollars were funnelled into our black hole couldn't be further from the truth," he said.

The president of the Australian Salaried Medical Officers Federation (NSW), Tony Sara, said the Government must launch an investigation. "We can't have hospitals gambling away vital funds. Staff specialists have undertaken research on the understanding that this money was secure. For them to now turn around and find out that that's not the case is disappointing to say the very least." He said money was also lost from accounts used to pay doctors' salaries. "The personal funds our members have lost must be reinstated immediately … We have already written to St Vincent's Hospital seeking clarification and their legal advice on how they have allegedly allowed this to happen," Dr Sara said.

The hospital said it lost 32 per cent of its investment because it bought securities known as collaterised debt obligations, which are now worthless, but defended its right to use public money. "Trust money gets banked and sometimes the family stipulates we invest that money and use the interest to buy equipment so it is an enduring bequest," the hospital's spokesman said.

In a letter to colleagues, obtained by the Herald, pathologist Andrew Field said donors would not see it that way. "Donors will be extremely upset to lose their donated funds to financial mismanagement by the board. We believe this whole matter will badly damage the St Vincent's Hospital name."

The hospital yesterday promised to underwrite any lost money allocated for research projects and said it had changed its investment strategies since the loss. "St Vincent's has always acted prudently and has conservatively invested in Standard & Poors AA-rated or better portfolios," the spokesman said. "We're very sorry this has happened. We can understand why the doctors feel the way they do, but we did not operate outside the law in the way the money was invested and a lot of companies have had to take sobering losses." [So irresponsibility is OK as long as it is legal??]

The Greens health spokeswoman, Lee Rhiannon, said taking risks was "a sign of a hospital system under stress". "If NSW hospitals were fully funded this quest to find extra cash through dodgy investment schemes would be unnecessary," she said.

The decision to invest was overseen by the former chief executive officer, Mary Foley, and a former chairman, Nick Curtis. Neither still works at the hospital.


Australia a top place to live, say expats

EXPATS rate Australia as the second best place to live in the world, according to a new survey. More than 3000 people living abroad in more than 50 countries responded to the Expat Explorer survey by HSBC. Australia's weather, lifestyle and the ability to integrate with locals came up as the reasons why people voted for Australia.

Canada was voted the best, followed by Thailand and Singapore. Qatar, India, Russia and the United Kingdom ranked poorest.

Those who took part in the survey were asked to vote on food, social life, accommodation, healthcare, working hours, family life, ease of organising finances, ease of finding accommodation and ability to make friends in their adopted country.

HSBC Bank Australia's head of personal financial services Graham Heunis said there was a distinct trade-off between income and overall quality of life. "What is clear is that in locations where salaries may not be as high, like Australia, expats are enjoying not only an increased quality of life but are also finding it easy to fit in to their new communities," he said.

Over half of expats living in Australia own property here compared to the global expat average of 31 per cent.

The survey also confirmed that expats generally enjoy a better quality of life once they move away from their country of origin - so good they are choosing to stay abroad. More than half have lived abroad for more than five years, compared with 45 per cent last year and one in five expats have found love overseas.

Almost half said the better environment and quality of life for their children was the number one reason for staying while 45 per cent said it was experiencing an improvement in their personal health. While making friends is easy for most expats, they prefer to make friends within the expat community


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