Friday, 15 May 2009

A whinge about the Australian health system

At the moment, there's a bit of a ding-dong battle going on between Australian Labor and the Liberals over healthcare. The usual accusations are that Liberals want to do away with public healthcare and push everyone onto private insurance, while the Liberal supporters moan that Labor wants to do away with private insurance and have socialised healthcare.  The two parties' supporters, of course, often have arguments about it on forums and in comments about news articles.  I'm not especially political, but there's a rhetorical attack, borrowed from Republicans in the US, that gets used quite often on forums: "be warned, if they socialise medicine, it'll turn into something like the NHS"

Well, in case any Australians happen to read this post, perhaps via Google, I'd just like to express this personal opinion:

Every British ex-pat I know in Australia, my own family included, longs for the Australian system to become more like the NHS. Under the NHS we had a home water-birth attended by two midwives; no cost. (In Brisbane, from what we can tell, that would be prohibitively expensive.) Midwives or health visitors then came round frequently as a matter of course over the next few weeks to check things were well, help with breastfeeding, etc, regularly over the following. No cost. And no having to search for one. All the GPs were trained in how to do six-week baby checks (except of course we flew to Aus before then), and the local practice had nurses trained in many of the regular adult checks, so somethings that you'd get charged $100 for a doctor's appointment in Aus wouldn't even require a doctor's appointment under the NHS.

Everyday healthcare in Brisbane involves cost and a fair amount of inconvenience. A week or two ago, the campus practice nurse suspected I might have measles, which is a notifiable disease and is important to diagnose quickly for public health reasons. But they had no appointments, so I had to catch a bus (yup a nice crowded one where I could spread it around) an hour across Brisbane to get to a GP who would be able to give me an appointment that day. (Thankfully, it wasn't measles.) Our child's GP, meanwhile, is on the other side of the city from where we live, because apparently it's really hard to get a pediatrician, and that's the closest GP we heard about who was taking on patients and was known to do six-week baby checks.

Meanwhile, it seems Australians are pressured into taking out expensive private insurance that from what I can tell reading the small print, doesn't actually seem to cover much of anything. Although it keeps stressing how important it is you check whether your doctor participates in this particular company's GapCover scheme and what their copayments are, yadda yadda, whole bunch of small print economics details I really won't want to be thinking about if I ever need an operation.

The key difference seems to be that in a socialised healthcare system like the NHS, it is a government responsibility to ensure that doctors and healthcare are readily available and easy to deal with, and so the public at least has some possibility of holding them to account. Under a private provision system, even with Medicare, if medical services are not available or not easy to deal with "well, you'd have to take that up with the private company in question".

1 comment:

djfoobarmatt said...

It so happens I was at hospital just the other day with appendicitis. While I was in the emergency room I had to have a discussion with my surgeon about gap fees and which private fund I was in! Also as a private patient I paid much more than I would have as a public patient but still received the same level of care as far a I could tell - I can't say whether the surgery was technically better or more well resourced though (and no I didn't get a private room either). One really questions the value of private health insurance yet we are scared into it by an entry age and tax penalty.

Your description of the services around child birth sound like heaven - especially with our first baby there was just no care including not being able to get to our two week check-up for six weeks because the paediatrician was over booked. There is also no support for post natal depression unless it becomes chronic (private patients can fork out $3k for a week at a clinic though - then you can have post natal credit card depression)