DESPATCHES FROM THE FRONTIER

A Question of Health

Jock Asiimwe reports on the state
of our bush health services

As I write this, my mother in law is in absolute agony with severe leg pains, and the on call doctor at Tennant Creek says she does not think she can justify sending a plane out to collect the patient. My mother in law has suffered silently for weeks now, and we have tried everything possible. She is diabetic, prone, like many diabetics, to decreased sensitivity in the extremities. When she complains of acute pain, I get concerned. But the doctor is worried about the cost of sending a plane. We are still under a public health system! What will happen when the announced privatisation occurs? It is bad enough that the Tennant Creek Hospital is suffering massive staff shortages at the present time. My experience with private hospital systems is that they employ a minimum staff, then call in agency staff to cover the peak times. That is fine in a large populated centre such as Melbourne or Sydney, but it is just not possible in Tennant Creek.
It is not a simple action transferring from public to private. Few would be aware of how governments fund the health care system, nor would it be expected of them. It is complicated, very complicated. But here is an example of one part of it. There exists a funding 'beast' called 'Casemix'. Put in its simplest form, the hospital is reimbursed for patient care based on the diagnosis. In the public system, this is not as critical as the private system, where profit is important. Let us say you are admitted for appendicitis. 'Casemix' may say that the hospitalisation period following surgery is five days. Therefore, the hospital is guaranteed five days worth of funding. If, however, complications occur and you are unable to be discharged after five days, the hospital is then expected to cover costs from day six onwards, from the hospital budget. If the hospital can get you out in four days, the government still pay the five days. At first glance, 'Casemix' has merit, it is an incentive to the hospital to ensure you receive the best care. However, what happens when the hospital is profit driven? The sooner the hospital could realistically discharge you, the greater the profit.
Now the private hospital is not about to push you out after two days, because of the 'checks and balances' that exist within 'Casemix'. If you are discharged too early, and require hospitalisation soon after due to complications, the hospital must bear the cost. So it is in the interest of the hospital to ensure you are right.
So why be concerned? Well, let's look at some of the companies who are moving into private health care. One of the major players in Australia is Mayne Nickless Transport. They have vested interests in a number of hospitals down south, and having done work in some of them, they are certainly well appointed, and the staff show genuine interest in your ongoing care. Equipment is up to date and all your needs are catered for.
The company has a good approach towards staff management, and certainly seem quite genuine about delivering the best care available. But to receive the best care, you need health insurance. Most of us in the Territory are not able to afford the high premiums. What of other private health companies though, not all are as interested in care. Profit is the driving force.
Of greatest concern are services to the bush. We, by virtue of geography, come under the Barkly Mobile Section of Territory Health Services, Tennant Creek. The staffing level is meant to be one doctor, two registered nurses and two Aboriginal Health Workers, however, it currently stands at one Aboriginal Health Worker, and he is fast burning out from overwork and stress. He is the sole medico for the Barkly region outside Tennant Creek. That is quite a burden for one person. But what can the hospital do? There is a chronic staff shortage, current staff are working extra shifts to ensure proper care is ongoing. They may be paid well in overtime, but that fails to make up for lost rest time, time with families, and working extra shifts ultimately sets in place a vicious cycle of sick leave due to stress and over tiredness, which in turn puts pressure on the remaining staff, and in the long term, can lead to mistakes in patient care. It has been suggested that up to 40% of deaths in hospitals are due to staff errors. The errors are certainly not intentional, they simply occur due to excessive stress. Try working up to 60 hours a week, at odd times night shift mixed with morning shift, mixed with afternoon shift. You have no routine, and soon burn out. Sadly, altruism is fast causing the early burn out of too many staff.
We are supposed to receive monthly clinic visits by the Barkly Mobile Section. We have received one in the past eighteen months. This is not what the Barkly Mobile Section want, but due to budget cuts, that is all they can afford. The hue and cry about the poor state of Aboriginal health needs to lobby governments for greater funding. A recent 'Health Report' on Radio National cited spending on Aboriginal health as being 40 cents spent per Aborigine to every dollar spent per non-Aborigine. I would not be surprised if it were little more than 40 cents per person living outside the eastern sea board. I know personally of stations in the Northern Territory which opt for medical evacuation to Mount Isa because they believe they get a better deal from the government that side of the border. Having worked in remote areas much of my career, I believe that patient care is equally as good either side of the border. But as more and more services are relocated from Tennant Creek to Alice Springs, by bureaucrats who have little knowledge of anything between Adelaide and Berrimah, let alone Tennant Creek, quality must fall in line with staff morale.
And as for private health services outside the towns? If the Territory Health Services see the remote services as an enormous budgetary burden, no private health provider would show any interest in continuing services. It is bad enough that the dental service is so overloaded in Tennant Creek that the senior dentist suggested we just step over the border and access the Queensland Dental Service.
The new Minister for Health suggested recently on ABC Regional Radio that he wanted to be the minister who solved the Aboriginal health problem. A rather grandiose statement to say the least. It is wonderful to think he is so concerned about the problem, but is it rhetoric like all those who have preceded him. I think he needs to realise that the crisis is not restricted to Aborigines, but encompasses the whole Territory. We are sick from yelling in the bush about deteriorating services, do not allow the cancer to continue metastasise our hospital.
This new aircraft for bush health services
has been specially designed to cut costly engine maintenance.
Whether or not it flies around in circles chasing its tail remains to be seen.

A Question of Health Jock Asiimwe reports on the state of our bush health services As I write this, my mother in law is in absolute agony with severe leg pains, and the on call doctor at Tennant Creek says she does not think she can justify sending a plane out to collect the patient. My mother in law has suffered silently for weeks now, and we have tried everything possible. She is diabetic, prone, like many diabetics, to decreased sensitivity in the extremities. When she complains of acute pain, I get concerned. But the doctor is worried about the cost of sending a plane. We are still under a public health system! What will happen when the announced privatisation occurs? It is bad enough that the Tennant Creek Hospital is suffering massive staff shortages at the present time. My experience with private hospital systems is that they employ a minimum staff, then call in agency staff to cover the peak times. That is fine in a large populated centre such as Melbourne or Sydney, but it is just not possible in Tennant Creek. It is not a simple action transferring from public to private. Few would be aware of how governments fund the health care system, nor would it be expected of them. It is complicated, very complicated. But here is an example of one part of it. There exists a funding 'beast' called 'Casemix'. Put in its simplest form, the hospital is reimbursed for patient care based on the diagnosis. In the public system, this is not as critical as the private system, where profit is important. Let us say you are admitted for appendicitis. 'Casemix' may say that the hospitalisation period following surgery is five days. Therefore, the hospital is guaranteed five days worth of funding. If, however, complications occur and you are unable to be discharged after five days, the hospital is then expected to cover costs from day six onwards, from the hospital budget. If the hospital can get you out in four days, the government still pay the five days. At first glance, 'Casemix' has merit, it is an incentive to the hospital to ensure you receive the best care. However, what happens when the hospital is profit driven? The sooner the hospital could realistically discharge you, the greater the profit. Now the private hospital is not about to push you out after two days, because of the 'checks and balances' that exist within 'Casemix'. If you are discharged too early, and require hospitalisation soon after due to complications, the hospital must bear the cost. So it is in the interest of the hospital to ensure you are right. So why be concerned? Well, let's look at some of the companies who are moving into private health care. One of the major players in Australia is Mayne Nickless Transport. They have vested interests in a number of hospitals down south, and having done work in some of them, they are certainly well appointed, and the staff show genuine interest in your ongoing care. Equipment is up to date and all your needs are catered for. The company has a good approach towards staff management, and certainly seem quite genuine about delivering the best care available. But to receive the best care, you need health insurance. Most of us in the Territory are not able to afford the high premiums. What of other private health companies though, not all are as interested in care. Profit is the driving force. Of greatest concern are services to the bush. We, by virtue of geography, come under the Barkly Mobile Section of Territory Health Services, Tennant Creek. The staffing level is meant to be one doctor, two registered nurses and two Aboriginal Health Workers, however, it currently stands at one Aboriginal Health Worker, and he is fast burning out from overwork and stress. He is the sole medico for the Barkly region outside Tennant Creek. That is quite a burden for one person. But what can the hospital do? There is a chronic staff shortage, current staff are working extra shifts to ensure proper care is ongoing. They may be paid well in overtime, but that fails to make up for lost rest time, time with families, and working extra shifts ultimately sets in place a vicious cycle of sick leave due to stress and over tiredness, which in turn puts pressure on the remaining staff, and in the long term, can lead to mistakes in patient care. It has been suggested that up to 40% of deaths in hospitals are due to staff errors. The errors are certainly not intentional, they simply occur due to excessive stress. Try working up to 60 hours a week, at odd times night shift mixed with morning shift, mixed with afternoon shift. You have no routine, and soon burn out. Sadly, altruism is fast causing the early burn out of too many staff. We are supposed to receive monthly clinic visits by the Barkly Mobile Section. We have received one in the past eighteen months. This is not what the Barkly Mobile Section want, but due to budget cuts, that is all they can afford. The hue and cry about the poor state of Aboriginal health needs to lobby governments for greater funding. A recent 'Health Report' on Radio National cited spending on Aboriginal health as being 40 cents spent per Aborigine to every dollar spent per non-Aborigine. I would not be surprised if it were little more than 40 cents per person living outside the eastern sea board. I know personally of stations in the Northern Territory which opt for medical evacuation to Mount Isa because they believe they get a better deal from the government that side of the border. Having worked in remote areas much of my career, I believe that patient care is equally as good either side of the border. But as more and more services are relocated from Tennant Creek to Alice Springs, by bureaucrats who have little knowledge of anything between Adelaide and Berrimah, let alone Tennant Creek, quality must fall in line with staff morale. And as for private health services outside the towns? If the Territory Health Services see the remote services as an enormous budgetary burden, no private health provider would show any interest in continuing services. It is bad enough that the dental service is so overloaded in Tennant Creek that the senior dentist suggested we just step over the border and access the Queensland Dental Service. The new Minister for Health suggested recently on ABC Regional Radio that he wanted to be the minister who solved the Aboriginal health problem. A rather grandiose statement to say the least. It is wonderful to think he is so concerned about the problem, but is it rhetoric like all those who have preceded him. I think he needs to realise that the crisis is not restricted to Aborigines, but encompasses the whole Territory. We are sick from yelling in the bush about deteriorating services, do not allow the cancer to continue metastasise our hospital. This new aircraft for bush health services has been specially designed to cut costly engine maintenance. Whether or not it flies around in circles chasing its tail remains to be seen.		This new aircraft for bush health services has been specially designed to cut costly engine maintenance. Whether or not it flies around in circles chasing its tail remains to be seen.