Doctor and activist
25/07/2018
25 July 2017 It is good to have a health record available for a complicated case. It saves doctors a lot of time. When Records started to be computerised in the early 1980s the people at North Shore Hospital where I worked had a working party. I offered to help, but they said that they […]
11/10/2017
11 October 2017 It is getting harder to trust people. Once we trusted our teachers, our doctors, our bank managers and our politicians to lead us. And people trusted that people could do their jobs. But we became obsessed with competition instead of cooperation. Everything had to make money. Everything was a commodity. It was […]
28/09/2017
28 September 2017 People who see the world from a very narrow perspective generally get it wrong, however clever they are in their own specialty. If the only problem in health were smoking, perhaps vaping could be justified. But the realities of money and marketing is that a whole industry will try to get the […]
01/07/2017
1 July 2017 I have grave fears for this system. I am unsure even of the goodwill of some of its advocates. I was on the Social Issues Committee of the NSW Parliament and we looked at Disability services and the way that these were delivered. Basically if you ask how big the disability problem […]
26/11/2016
26 November 2016 Power, Injury and Awards. I work in medicine, treating mostly third party motor vehicle injuries and workers compensation injuries. There are much fewer of the latter because there are less employees. Many people working as couriers are ‘self employed’ contractors. One man had to pay $75,000 for the right to deliver parcels […]
11/09/2016
CTP, Compulsory Third Party insurance (Green Slips) is an area where I work. In theory, if you are injured in an accident that is not your fault, all your treatment is currently paid for by your insurer. The law says that they must pay for ‘reasonable and necessary’ treatment, which I assume to mean the treatment that would happen in good routine medical practice. Wrong.
The insurers have 3 months to decide if they are liable for the accident. If they decide they are not they will not pay. If they decide that they will pay, all treatment decisions have to be referred to them as to whether they will pay or not, and sometimes, despite MRI scans, severe symptoms and a neurosurgeon saying that their life is at risk, they will not pay. I have a number of patients who have waited over a year in agony for treatments that are both reasonable and necessary but the insurers will not pay for. They say that the patients can get it themselves if they like (obviously if they can afford it), of they can get it on Medicare (if they have Medicare and if they can find a surgeon who will operate on Medicare for a third of the money that should be paid by the insurer. Such surgeons cannot be found).
The protocol for disputes vary slightly between insurers. For example, the NRMA protocol is that you can firstly approach the claims clerk who rejected it and ask him/her to change their mind. Secondly you can appeal to their team leader. Thirdly you can appeal to the NRMA Senior Claims Manager. Fourthly you can appeal to the government appointed Medical Assessment Service (MAS), which guarantees to assess the disputed issue and rule within 3 months! Or the treating doctor can try to find a Medicare surgeon, send them to a public hospital, or write yet another prescription for pain killers. (Mostly the insurers pay for pain killers, though they do argue over some other drugs). Many GPs have simply given up treating CTP patients.
All these delays, frequently running into months can be compared to the doctors and nurses in Emergency Departments of public hospitals who have to write long explanations for the Health Minister if patients wait more than 4 hours in the Emergency Departments. So if you think private medicine is better than public- think again. We are going the way of the US. Insurers control it all.
Patients are assesses by an iniquitous system devised by American Insurance companies in cooperation, (inexplicably enough) with the American Medical Association. This has resulted in a tome, the ‘AMA Guidelines for the Assessment of Permanent Impairment’ which supposedly gives a percentage of impairment of your body, so that injured people can get compensation based on the percentage impairment that they have. Doctors can do a course in how to use this guidebook and then do lucrative medicals based on it. The reason the book was produced was to lessen litigation on how injured someone was, which would save legal costs. As pain cannot be measured, this was left out, which is just the first reason why the book is a farce. Since pain is the main thing that stops people working, to talk of impairment without considering pain is almost like having a swimming race without water- just not quite. Secondly despite the tome’s carefully crafted descriptions, doctors assessment using the guidelines vary widely. Thirdly, it is very hard to get over 10% impairment, which is the amount Mr Baird’s reforms intend to define as more than a ‘minor injury’ so there will be many people with only a few percent impairment, and thus minimal compensation, who will be unemployed and unemployable. Fourthly, the guides only talk of ‘impairment’. Any one who works in disability knows that there is quite a difference between an impairment and a disability. For example if someone is very shortsighted they are impaired, but if they have good prescription glasses they may not be disabled by that impairment. People who work with their brains are similarly less disabled than those who need their physical strength, but have the same impairment. So physical workers are again disadvantaged.
The new scheme will cut out lawyers and advocacy, and will give a statutory small amount to ‘minor’ injuries. The insurers will dump long term patients on the welfare system and continue to get a lot of money for doing not much that is useful.
I would finish by saying that I think the whole system is appalling and that the way to solve the health system problem is to raise the Medicare rebate from 48% of the AMA fee to 85%, where it was when it started, and there would be no trouble getting doctors to treat the patients who needed it. There also needs to be a single insurer, so that disputes between insurers will not delay treatment, which they frequently do, and everyone should be covered, even ‘at fault’ drivers, who still need treating despite their error.
For the present six insurers, all are bad, but they are not all as bad as each other. There are no published figures to compare them rationally, but based on personal experience, I have just changed my insurance from NRMA to GIO. The TV ad about feeling ‘confident’ about your insurer is a bad joke.
Wish me luck, as I wish you.
Here is an SMH article by Anna Patty 12/9/16 which raises the issues in a somewhat understated way.
www.smh.com.au/business/workplace/green-slip-reforms-will-leave-most-motorists-to-fend-for-themselves-20160905-gr8zca.html
29/06/2016
Some years ago, my attention was drawn to a 2007 book, ‘The Shock Doctrine: The Rise of Disaster Capitalism’ by the Canadian author and social activist Naomi Klein. The idea was that if a coastal community was blown away, say by a Tsunami with a loss of owners, records etc, some coastal land could be […]
21/06/2016
21 June 2016 This is a current question with Shorten claiming that the Liberals are trying to privatise it and Turnbull calling this a Labor lie. What is the truth? The answer is in the history of Medicare funding. Medibank was set up by the Whitlam government and the bulk billing frees were set at […]
21/06/2016
This is a current question with Shorten claiming that the Liberals are trying to privatise it and Turnbull calling this a Labor lie. What is the truth?
The answer is in the history of Medicare funding. Medibank was set up by the Whitlam government and the bulk billing frees were set at 85% of the AMA ‘Most Common Fee’. The 15% was a discount but saved doctors a lot of costs and all their bad debts. They got slightly less, but the clerical and hassles saved by simply sending the paperwork, and later the computer message to the Medicare computer was felt to be a good deal. But ever since then both major parties have not raised the Medicare same rate as inflation, in fact at about half the inflation rate. This has resulted in the Medicare rebate being about half the AMA fees. Specialists often will not see patients on Medicare unless they have a Health Care card, and GP practices simply cannot survive if all their patients are bulk billed. GP practices have survived by having pathology companies rent a room where they collect bloods for a relatively high price. This has allowed the government to keep the GP Medicate rebates low. Recently the government tried to change the pathology rebates, and the companies resisted, but the treat was that the pathology companies would stop subsidising GP rental and a whole fuss would have erupted re the uneconomic nature of General Practice. The government did not want this just before an election, so the pathology system was left as is. But can we trust the Turnbull government? I don’t think so. A couple of other pointers:
The Emergency Departments (EDs) have recently been in the news as having a hugely increased workload and there was a request for funds, also recently seen as a question to Turnbull on Q&A. EDs get busier if people do not go to GPs, who are far cheaper, and generally pick up problems earlier than EDs. So the rise in ED use is likely to be a reflection of the lack of funding of GPs by Medicare.
There have been a lot of rather convoluted plans to deal with chronic illness. As the population ages, and as it gets problems with obesity and diabetes, there are more visits, more prevention is needed. GPs are the cheapest medical intervention, so one might have expected that they would be the key element in the strategy to deal with it, perhaps supplemented by practice nurses or other slightly cheaper options based around GP-type community health centres. But instead of this there was a bemoaning of the difficulties and lot of convoluted nonsense trying to avoid raising GP payments to a viable level. It looked very like the object was not to find a solution to the problem, so that Private Heath insurers and the profit sector could get a look in at the problem and start to make some money.
Now we hear that there has been $5 million to look at outsourcing, just the payments part of Medicare. Well Medicare is Just a payments system, so that is the guts of it.
So it is very likely that the Libs want to privatise Medicare and take us to a US model of the health care. The public do not want this, but big business does, a powerful lobby in Canberra does, party political donors do, and the government can lessen the amount it pays for health, even though the total cost will rise dramatically.
Labor also has historically a very bad record. They have allowed the Medicare rebate to fall with inflation, had a rebate ‘freeze’ of their own, and their only promise is to stop the freeze, which still leaves most doctors either unwilling in the case of specialists or unable in the case of GPs, to survive.
20/06/2016
20 June 2016 The Queensland Parliamentary Finance and Administration Committee has reported on the need for regulation of contact sports in Queensland. It resolved to do nothing! Currently only Qld and Northern Territory are ‘self regulating’. There were 8 submissions, 3 from medical associations, (AMA College of Surgeons, and Qld Brain Institute), 4 were from […]