.
MYTH
BUSTING
The Australian health care debate has often become a battlefield in which
politicians, doctors, nurses, health bureaucrats and private sector companies
continually exchange blows. Many key players seek to use the debate to gain
leverage for their own arguments and horror stories - and the resulting
confusion is only exacerbated by news headlines which regularly announce 'health
crisis', 'long waiting lists', 'cost blow-outs' and 'problems with care'.
It's time to examine the true state of health care in this country: to tackle
the myths about Medicare and to let the Australian public examine their health
system clearly and fairly.
MYTH 1:
'PUBLIC HOSPITALS ARE COLLAPSING'
Reality check:
Public hospitals are under stress. The latest available figures show over 5
million admissions per annum by Australian hospitals, with public hospitals
accounting for approximately 70 per cent (AIHW, 1998, p198).
Between 1991-1992 and 1995-1996 there was a 22 per cent increase in public
hospital admissions. At the same time, average length of stay fell from 4.8 days
to 4.3 days, largely due to a greater focus on day surgery (AIHW,1998, p 200).
Public hospitals also provide over 3.4 million outpatient and emergency
services per year (AIHW, 1998, p 204).
Waiting times for elective surgery have often been used as an indicator of
crisis in hospitals and the figures strike a resonance with the community. No
one wants to wait when they are in need of care, although most people understand
that urgent cases must be dealt with first.
Despite the bad publicity, the
reality is that Australia has similar waiting times for elective procedures as
Canada and New Zealand. We significantly outperform the United Kingdom on
waiting times. And despite popular belief, a recent survey found that overall
estimated clearance times (the time it would take to clear waiting lists) are
actually falling (AIHW, 1998, p 209).
Australian public hospitals are clearly not collapsing.
Some commentators say that increased patient demands and rising expectations
are placing pressure on the public system. However, changes and reductions in
government funding have played a major role. Neither the State nor Federal
governments have consistently provided an adequate growth in funding.
MYTH 2:
'AN AGEING POPULATION LEADS TO AN AVALANCHE
OF COSTS'
Reality check:
National and international analyses of trends over the past ten years have
consistently punctured the claim that an ageing population is the chief cause of
high demand and cost blow-outs.
An OECD report of 17 countries found that through the 1980s the impact of an
ageing population on the growth of health costs was at most 0.3% per annum.
Projecting into the next century this same report was able to attribute - at
worst - a rise in health costs of only 0.7% per annum due to an ageing
population.
Comparable countries that already have ageing populations, similar to those
forecast for Australia well into the 21st century, do not report health care
costs higher than ours are now.
In fact, the largest driver of new and higher costs continues to be the
impact of new technologies and "supplier induced demand" (Oxley &
MacFarlan 1994).
Older people are getting healthier and staying healthier longer. While the
elderly have always been major users of health care, the pressure on the health
system due to ageing will get proportionately lighter by comparison with earlier
times. (Sax 1993, Frics 1989, Rowland 1991, McCallum & Geiselhart 1996,
Richardson 1999)
MYTH 3:
'MEDICARE SHOULD BE A SAFETY NET FOR THE POOR
- THE WELL OFF ARE
FREELOADING ON THE PUBLIC SYSTEM'
Reality check:
The strength of Medicare is that it is for all of us! Everybody pays a fair
proportion, dictated by his or her income. The "well-off" pay more
because they can afford to do so. If Medicare became only a safety net for the
"poor" and the more "well-off" were "encouraged"
to use the private health system and contribute less to Medicare, Australia
would see the destruction of our equitable health system.
If Medicare was no longer universal, well-off people would no longer have a
stake in its quality. The poor and sick would then be worse off, not better, as
the level and quality of care declined. Even in financial terms, keeping the
better-off people contributing to Medicare makes much more budgetary sense than
any "opting out".
MYTH 4:
'MORE PRIVATE INSURANCE WILL HELP PUBLIC
HOSPITALS'
Reality check:
Private health insurance contributes a very small amount to the entire health
care system. It has been estimated that a rise of about 1% in the Medicare levy
would easily provide the same amount of funds that private health insurance
contributes to health care. Funding of the health system through private health
insurance is also very inefficient.
Private health insurance companies spend 13.5% of their funds on
administration whereas Medicare only uses only 3.5% of its funds for
administration (Livingstone 1997). Dollars provided through Medicare therefore
"buy" more direct health services.
It is important to stress that money paid by consumers to private health
insurance companies does not buy health services - it buys insurance. Some of
these funds go into reserves, effectively becoming "dead money" which
does not produce health care.
The Commonwealth Government's recent 30% private health insurance rebate has
mainly replaced $1.6 billion in private health insurance premiums previously
paid by consumers. There is no guarantee that public hospital demand will fall
as a result.
Public hospitals are a major supplier of some services (eg. research,
emergency services, care of the chronically ill and staff training) not
generally provided by private hospitals.
MYTH 5:
'INTRODUCING CHARGES FOR PUBLIC HOSPITALS
WILL FIX THE PROBLEM'
Reality check:
Often people suggest that co-payments, or user charges, will reduce demand
for public hospitals. However, international evidence suggests this would not
happen to any significant extent. In fact, the main impact would be financial
and it would hit hardest for those most in need - people on low incomes, their
children and those with poor health. For more information about co-payments, see
Richardson J, 1991).
CONCLUSION
In a modern democracy, it is inevitable and desirable that different groups
will have different viewpoints. This is as true concerning health care as it is
about anything else. But we can at least demand that they rely on facts not
myths to argue their case. Australia's health is too important to expect
anything less.
References
