Cross border health issues must be resolved
For three months Australia’s world-class health system refused to treat Thornlands’ Della Johnson who has a rare vascular disease of the brain called moyamoya. The reason: she’s a Queenslander. More precisely, she lives on the Southside of Brisbane, sees doctors on the north and needs an operation interstate.
If she lived in New South Wales, she would now be cured; months post-operation and free of her horrible symptoms. But she comes from a smaller Australian state which lacks a surgeon trained in this ‘one in a million’ procedure.
Her battle for life-saving treatment captured media attention nationwide because it exposed a flaw in our world-class federated health system. Australians are divided into eight public hospital systems and scores of hospital regions. Those boundaries can mean delayed health care and unquantifiable mental anguish for those trapped in unfortunate postcodes.
For years, patients copped being told hospitals were doing ‘all they could.’ Now the internet offers cutting-edge options to patients before doctors have even heard of them. At her wits’ end, Della found the Sydney surgeon trained at Stanford in moyamoya and demanded referral.
It is a problem which won’t go away. Each Australian state does offer virtually every medical procedure its population needs. But with a health system just a twentieth the size of the US, there is always a handful of sub-specialised procedures available in just one or two locations.
Unfortunately hospitals charge interstate patients top dollar, in other cases they struggle to get payment from the hospital region where the patient originates. These cross-border challenges differ each time. It leads on occasion to home states deferring, delaying or reluctantly delivering care. Patients shouldn’t have to rely on media to get treatment. Nor should they live with worsening health while their hospitals pawn them interstate in search of cheaper treatments.
This interstate dilemma applies to ‘old school’ operations as much as it does the breakthrough operations for rare diseases. Since platinum coiling superseded clipping of brain aneurisms, only a tiny number of severe cases now need cranial surgery. It makes sense that this delicate but infrequent procedure also rests with a handful of really competent surgeons. Imagine having the choice of two great surgeons; one does the operation every week, the other once a year. At the moment, smaller states persevere with low-volume surgery simply to avoid being billed by its neighbour.
Australia needs a streamlined system to ensure rare conditions are in the best hands. Usually that is where surgical volume is greatest. At present, securing an interstate operation means negotiating from scratch. Bringing interstate surgeons and their operating team to Queensland is not usually feasible, due to unfamiliar conditions and post-operative risks in recovery. In Della’s case, Queensland Health face a $60,000 private hospital bill, simply because a Sydney public hospital couldn’t offer surgical time to the surgeon volunteering his time.
The recent federal Government health and hospital reforms focus almost entirely on efficient pricing, data collection and integrating primary health care. That’s commendable if achieved, but it won’t help cases like Della. If anything, a fourth level of bureaucracy at hospital and Medicare Local level risks further treatment delays. That’s because individual health regions in large cities securing autonomous budgets present an additional barrier for interstate patients to secure the care they need.
These rare cases are spread equally around the nation and there are no alternatives to care. For the many procedures available only in Sydney or Melbourne, Queensland would be the lead beneficiary of a streamlined system that avoids unnecessary delays, bureaucratic struggles and sideshows. That is why our state should take the issue of interstate treatment to the Health Ministers’ meeting and negotiate an enduring solution.
Andrew Laming is the Shadow spokesperson for Aboriginal Health and Regional Health Services, and former eye surgeon and relief worker.
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