Doctors’ bills

If I were Tony Abbott, I would be carefully listening to doctors’ whinges about medical insurance—noting every claim about the costs imposed on their income by the risks of medical misadventure, whether caused by negligence or not. Because the key to any solution is that government assume this burden, but there’s no reason why doctors should benefit much as a consequence. For example, if an obstetrician is paying in insurance half of what she or he receives for the birth of a baby, then it would be a fair bargain if government paid the practitioner half as much as before. It might be wise for government to subcontract the actual management of a claims system to a number of competing private funds, rather than running a national medical insurance agency directly. Private health insurance companies should also be required to contribute their share for every procedure performed. They might be keen to do so since now they have as much interest in keeping medical costs down, and doctors under some leash, as government itself.

Two years into the medical insurance crisis, it is still assertion rather than evidence which governs the debate. A major doctors’ insurer collapsed, but whether that was because it had set its premiums too low or because medical negligence payouts had skyrocketed is far from clear. The evidence of court-ordered payouts does not support the idea of a massive escalation in claims or in amounts awarded. The courts were widening their definitions of negligence, embracing concepts of informed consent and the duty of a doctor to canvas with a patient what could go wrong with a medical procedure. This caused widespread panic in the profession, but it does not of itself seem to have produced a major increase in payouts. However, governments have been spooked by doctors’ panic and have severely wound back the law to reduce the ambit of claims.

But it’s perception as much as fact which governs the politics, and which has accentuated the uncertainties of doctors, made them withdraw services or types of services, or export their risk to the public hospital system, or threaten to leave their profession altogether. Or to practise, in the name of conservative medicine, the very antithesis of it: doing everything, just in case. Even those who think doctors are overreacting will concede a good deal of uncertainty.

But there’s another reason why government should get involved. Most people who suffer from medical accidents do not, can not sue. They cannot establish negligence. Something more than a mistake, more than a less-than-perfect outcome, must be demonstrated: it must be shown that the doctor’s treatment fell outside acceptable standards. Or that the doctor’s failure to outline possible risks and side effects meant that the patient did not really consent at all. That’s a hard standard. For the hundreds who collect, there are thousands who cannot, and they are compensated, if at all, only by the social security system. Two people may have identical injuries as a result of the failure of surgery. One may get millions, the other perhaps $200 a week.

Does the public really accept that? After all, the taxpayer is paying in both situations. In a high proportion of cases, the public hospital system pays. And even when the suit is against the individual practitioner, the premium cost has been loaded into her or his fees, and these overwhelmingly come from the public purse, whether directly from Medicare or indirectly through the tax subsidisation of health insurance.
One could not expect government to go the further distance and develop a national compensation scheme along the New Zealand model—one that abolished concepts of negligence in virtually all classes of personal injury and provided rehabilitation and compensation based on the type of injury involved. That might be too much like the welfare state for any modern government, let alone a conservative one.

The Opposition, of course, is suggesting that the shifting of Abbott into health is a sign of the government’s malevolent intentions towards the Medicare system. Any changes to the model—whether to the public hospital system, about bulk billing, or about permitting co-payment—are seen as sinister, the more so now that an able ideologue, such as Abbott, is involved. Kay Patterson might have been sinister too, but lacked the ability to carry out the government’s agenda.

John Howard is not as mad as that. Health care is one of the few areas where the Opposition has any traction, and raising concerns about the future of Medicare is an effective tactic. Health care is becoming more expensive, partly because the population is ageing and because of the sophistication of some modern treatments, such as hip replacements. Although Australia has successfully kept a lid on drug prices, the total cost of the pharmaceutical benefits scheme is increasing in real terms. The biggest boost that public hospitals have received is in the way private hospitals have picked up an increasing proportion of the load. But the public health system is still handicapped by poor planning, by cost-shifting between the Commonwealth and the states, by an increasing crisis in health care staff, particularly nurses, and by the failure of the states to invest in new facilities or maintain what they have. The Commonwealth’s charge that its extra funding is often matched by the withdrawal of state funds is essentially true; so long as the states can blame the Commonwealth for everything, they will. Brian Howe could not achieve much in the way of reform; Michael Wooldridge achieved even less. Kay Patterson could hardly make a decision. Tony Abbott, who can hardly stop making
decisions, may actually get somewhere.        

Jack Waterford is editor-in-chief of the Canberra Times.

 

 

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