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Filed under: Disease, Health, Health Reform

22 comments

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.

The bureaucracy is almost as bad as the brain disease. Pic: Lyndon Mechielsen, The Australian.

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 Since platinum coiling superseded clipping of brain aneurisms, only a tiny number of severe cases now need cranial surgery.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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22 comments

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- Diane says:
  
  04:25am | 13/08/11
  
  It’s the improved “data collection” that’s the worrying bit. Do patients have a say in that? What if we don’t want our medical records shared around without our consent? What if we don’t want medical records at all? Why are doctors still allowed to keep notes about our sensitive medical issues without needing our consent to do so? And do they really think compulsory medical record keeping doesn’t lead to less openness?
  
  Patients should be in control of their data.
  
  Reply
- Kassandra says:
  
  11:16am | 12/08/11
  
  This really isn’t a problem that needs to be there at all.
  
  In the old days we had tertiary teaching hospitals that were funded to provide specialised services to people who needed just that - specialised services. It didn’t matter where patients came from it just mattered that they needed something that was uncommon so not available outside the big centres.
  
  What has changed is the bureaucracy running the system. Instead of being funded to provide defined services hospitals are now funded to service a defined population. If you are outside the defined population then your local service has to “buy” what you need from another service. It’s idiotic.
  
  To a senior doctor running a clinical service one-off problems like this one aren’t really a problem at all but to a bean counter it’s insurmountable, because none of their 15,000 policies, guidelines, protocols, care pathways or clinical business rules addresses it exactly. If you want better clinical services then put clinical staff back in charge of them and put the bean counters back where they belong - supporting clinical services rather than running them.
  
  Reply
Against the Man says:

10:20pm | 12/08/11

Just remember, Gillard is lauging all the way to the bank. She screwed over Kevin and she is lauging at YOUR family’s suffering!

You gonna let Juliar get away with incompetence!

HaHaHaHa Juliar is toasting to YOUR suffering! : )
Mrs Doyle says:

09:08pm | 12/08/11

I work in a Tertiary teaching hospital, and there are only some (common) services that we have catchment areas for. If there’s a hospital closer to your home that can provide the same service you need, then we’ll redirect the referral there.
Otherwise, if we have the specialist services you need, it doesn’t matter where you live!
This must be a Queensland thing, I’ve never heard of it happening in Victoria.
There is an ESAS program which pays a private hospital to have you operated on as a public patient - it helps get the waiting lists down and prevents being fined by the government for long waiting periods.
This seems to be more of a problem of finding a surgeon who is employed by a public hospital and able to perform the surgery rather than needing to go private to get the expertise needed.
Surely if it was a private surgeon, medicare would just fund the procedure and get it done in a public hospital? It can’t be that hard.
- Lee says:
  
  10:36am | 12/08/11
  
  You think it would better under liberal states and feds? So where is Abbott gonna find his $70B? You tories better be careful what you wish for.
  
  Reply
The Badger says:

10:59am | 12/08/11

Double that and ask where they are going to find another $70 billion?

“The coalition’s plans to dump the carbon and mining taxes if it wins government won’t leave a hole in its budget, Shadow Treasurer Joe Hockey says.
Coalition documents leaked to the Seven Network on Thursday showed Opposition Leader Tony Abbott’s promise to axe the controversial taxes and implement other promises would leave a $70 billion shortfall.”

“Government minister Tony Burke said the opposition would not be able to make up the shortfall through cutting programs.
“If you’re going to have to find that much in cuts, you’re either going to have significant increase in taxes, significant cuts to the pension. They’re the only ways you can find that sort of money,” Mr Burke told Seven.”

http://tinyurl.com/43fwwk3
- Andrew says:
  
  10:11am | 12/08/11
  
  Both sides are to blame for this one. Federally run health care, should have been supported by both sides, at both state and federal level of politics. We are not being served properly by our politicians.
  
  Reply
Fiona says:

04:05pm | 12/08/11

Exactly. Working for Qld health you get to see just some of the wastage. I’m traveling to Sydney myself for my own surgery soon, paying up big too, but I don’t want to go back to the PAH.
- Sam says:
  
  09:38am | 12/08/11
  
  The biggest problem our Healthcare system faces is our Governments, both State and Federal.
  
  I am constantly amazed at how a State Government can smile broadly on the Nightly News stating that they are spending $40 , $50 or $60 Million dollars on a new sports stadium in the big city. They will be on TV with a beaming smile as they declare work to start on a new bridge over a road for Pushbike riders, or a new Jogging path to be built in the inner city.
  
  Now I live in Regional Queensland, in fact I live in Bundaberg, ground Zero of the Doctor Patel disaster. I dont care about a new sports stadium that i will never sit in and a vast majority of Queenslanders will never sit in, I dont care about pushbike bridges through parks, or jogging tracks! I care about sick Queenslanders being able to access quality Health care!
  
  I actually had to have surgery years ago, just after the Patel issue, in fact it was the type of surgery that Patel would have performed, so i thought “Thank Goodness, at least I wont have any problems, but alas, the severing of a major artery by a surgeon left me in very bad shape in Intensive Care.
  
  My sons Girlfriend needs knee surgery, she has been to see specialists at the hospital (after waiting months in between appointments). One specialist said “We need an MRI”, again she waited, finally got the MRI, went back to specialist (a different one again, you never see the same one), she said that surgery would be needed but wanted to make another appointment , my sons girlfriend went back (Months Later) and saw yet a different doctor who stated that they have lost the MRI, and he said she didnt need surgery, even though he didnt have the MRI to check!
  
  In Bundaberg becuase of what happened with Patel we should have the best Hospital, but we dont. We have great nurses and alot of great doctors but as public health patients we are at the mercy of visiting so called specialists and surgeons that cut through arteries in a basic operation.
  
  When I went into hospital it was to be keyhole surgery, an overnight stay and home the next day. I staggered out weeks later, instead of keyhole surgery I had staples running from the middle of my chest to my navel, plus staples and stitches in other holes they hacked into me, i now have a big long jaggered scar ( I tell everyone I was in a bar fight lol) running down my chest and stomach, plus all these smaller ones over my stomach.
  
  When I hear about State and Fedral Governments wasting money on unimportant things it just makes my blood boil ! Like the other week when the punch did a story of the Federal Government spending $150,000-00 on producing a DVD for aboriginals in Central Australia that had the Australian National Anthem sung in their language. I see Kevin Rudd donating $200.000,000-00 for something overseas, the money they have spent on schools in Indonesia, money spent in Timor, the Solomons, Pakistan etc etc etc.
  
  Spend the money here, get our system working to help all Australians, then and only then spend overseas. Stop wasting money on half-assed schemes and policies, think before you sign your name on something, but i know they wont listen, I mean why should Kevin, Julia, Tont Abbott, Anna Bligh or any other pollie care, they have private health insurance, they get the best care, while the rest of us have to make do with an ailing health system.
  
  Reply
- Against the Man says:
  
  07:47am | 12/08/11
  
  So straight after the Malaysian Solution F@#k UP we have Gillard and cronies coming up with a worthy sequel aka the Health Reform F@#k UP!
  
  Is anyone surprised? This is what Labor is all about
  
  Remember the Kevin O’Seven promise of 100% government take over of hospitals?
  
  Poor Juliar keeps failing in every way, and making no head way as fake PM. Keep enjoying the poorer health care Australia brought to you the Labor/Failure government!
  
  Roxon caught out again…........
  http://www.theaustralian.com.au/news/nation/doctors-taxed-on-grants-to-super-clinics/story-e6frg6nf-1226110463361
  
  Reply
- Mahhrat says:
  
  07:25am | 12/08/11
  
  I still don’t understand why the health system isn’t run federally.
  
  Reply
marley says:

07:02pm | 13/08/11

Graham - you do understand that my point was, the USSR was organized along federal lines and wasn’t as centralized as Knemon thought? That’s all we were really discussing. Are you actually going to argue with that?

As to the rest, a number of diplomats, senior and junior, in Hungary at the time told me that Janos Kadar always cleared items of major importance with the Russian Ambassador. And, given there were 100,000 Soviet troops in Hungary at the time, who would blame him? He still managed to introduce goulash socialism, though. But the Soviet presence in Hungary in the 80s was very present and very obvious. It all started to fall apart with Chernobyl, of course, when the Soviet Ambassador didn’t tell the Hungarians what was about to rain down on their heads. That’s a fact and quite easily verifiable.

In Ukraine, post Soviet era, I met a number of diplomats who had served with the Ukrainian MFA as opposed to the Soviet one. Ukraine had its own MFA. So yes, I’m going to make a wild guess that a republic of the USSR which was, on paper independent, also had its own Ministry of Health. I believe it was, at least in the 20s, called the People’s Commissariat of Public Health Ukraine.

And, given the Russian efforts to Russify Ukraine, Russian efforts to hide what happened at Chernobyl, and what the Ukrainians I know have told me, not to mention the solid historical evidence for the subjugation of Kyiv to Moscow, I’m also going to take a wild guess that Ukraine didn’t operate independently of its overlords in Moscow during the Soviet era. If it had, the famine of 1932 would never have happened.

So, that’s my position. If that’s not good enough for a casual blog, well sorry - but it’s a lot more evidence than you’ve provided to the contrary (which actually appears to be zilch).
graham says:

01:11pm | 13/08/11

Marley. You ask which of your “Facts” do I find factually incorrect.
1. It was “said” that the President etc
2. I am reasonably sure etc.
3. Obviously was in sync with Moscow.
So you’ve gone from reasonably sure to obviousy with no facts. I’d say that suggests you made up your own “facts” to suit yourself and to display your (lack of) knowledge
marley says:

08:23am | 13/08/11

@Graham - sorry, sloppy on my part - I realize there was no UN in the 1920s - what I meant to say is that Ukraine was structured as an “independent” republic from the 1920s, which is why it had its own seat in the UN from the 1950s. And its own Ministry of Foreign Affairs. But you can bet your bottom dollar it took its order from Moscow. What part of that do you find factually incorrect?
graham says:

05:03pm | 12/08/11

@ Marley or maraley. (You can’t spell your name, why should I worry).What a heap of nonsense. There was no UN in the 1920’s, and the rest of your rant is just as stupid. You obviously are a follower of conservative thinking which doesn’t require truth, just a rendition that suits what is increasingly called an entry for “wierdo of the day”. You win.
Knemon says:

03:14pm | 12/08/11

@ John A Neve - I fully agree with you regarding health in Australia, it’s a total mess, at least the ALP seem to be trying to bring in a workable solution. I agree even more with your idea of abolishing the states.
maraley says:

03:00pm | 12/08/11

@Knemon - fact is, the whole of Eastern Europe was answerable to Moscow right up to the 1980s - it was said that the President of Hungary took his orders from the Soviet Ambassador - but Ukraine had its own seat in the UN from the 1920s, and its own government and legislature. I’m reasonably sure it administered its own health system, obviously in sync with the Russian one.

So, in a way, it had some of the same powers and authorities as a state of Australia does today (though, Marrickville aside, I don’t think most local governments here seek to have their own ministry of Foreign Affairs). Sorry for the detour!
John A Neve says:

02:41pm | 12/08/11

Knemon,
You can agree or disagree with me, it really matters not. The fact is the current system is not working and there are many other cases where state and federal governments blame each other for the failures.

I’d vote for the Devil if he got this country on track, his current deciples obviously can’t.
Knemon says:

02:33pm | 12/08/11

@ Marley - I thought Ukraine were still answerable to Lenin’s centralist regime (whether they agreed or not) until Stalin totally destroyed any ideas they might have had for independence. Apologies to the author of this article for being off topic.
marley says:

01:48pm | 12/08/11

@Knemon - actually, he probably would not have. The USSR retained the fiction that it was a union of independent republics, so Ukraine, for example had its own ministries.
Knemon says:

01:19pm | 12/08/11

Spoken like true democratic centralists. Lenin would have agreed with you John A Neve.
John A Neve says:

11:20am | 12/08/11

Mahrat,

Agreed, the nation’s health should be a federal responsibility. Yet, another reason why state governments should be abolished. There is too much of the “it’s their fault, not mine”. This country thrives on the politics of blame.