Life-and-death healthcare needs reform, says expert
Sydney Morning Herald
Saturday February 19, 2011
THE extremely premature baby whose life could be saved at great cost is allowed to succumb. A 90-year-old patient is denied a life-supporting cardiac valve because of age.Such care-rationing decisions are already being made in resource-strapped hospitals but "off-stage" and without public discussion, says the former federal health minister Peter Baume.Professor Baume, a former physician, has called for an urgent debate on the issue he says health reformers have missed.He cites cases of reported limits on hip replacement joints and cataract surgery and the case of a friend, aged 88, who said he had been told if he had been two years older he would have missed out on a new heart valve operation.The Gillard government's promise to set targets to reduce waiting times for emergency and elective treatment have been criticised as unrealistic and distorting by hospital doctors. Professor Baume, a minister in the Fraser government, said in the Malcolm Shonell memorial lecture at St George Hospital at Kogarah this week that it was time the government acknowledged it cannot do everything possible for everyone."The sooner that unpleasant reality becomes part of the public discourse ... the better off we will be. We do not have an honest debate about rationing now."No one talks openly of what we can and cannot do, what we will and will not pay for, and essential rationing decisions are made 'off-stage' by people the general public - the payers - might not select, and away from the people who bear the effects of the decisions."People might still want more than we will pay for - if so, they can pay themselves or they can take an aeroplane to America."Medical leaders in Melbourne and Sydney told the Herald there was a need for more rational and considered debate on medical resource decisions but they also pointed out that on average a large share of health spending is outlayed in the last year of a patient's life.A professor of medicine at Melbourne University, Jeffrey Zajac, said the implicit rationing, already widespread in public hospitals, affected areas such as elective surgery for serious conditions such as hip replacements, implantable cardiac devices, surgical bands to treat obesity and expensive diagnostic scans such as magnetic resonance imaging (MRIs).But politics made it difficult for governments to encourage debate on choices, Professor Zajac said."It is clear no politician will get up and say, 'my policy is I am going to ration healthcare'."The federal president of the Australian Medical Association, Andrew Pesce, said that doctors are already having to make rationing decisions and these typically result from a squeeze on resources without public debate or discussion on the choices to be made."I think doctors find it very difficult to make the hard decisions when it comes down to the individual patient," Dr Pesce said.The dilemma facing the doctor - between devoting resources on a vulnerable patient that might be better directed elsewhere - "is an almost unbearable conflict of interest", he said.
© 2011 Sydney Morning Herald
