Concerns in Australian Public Health - Coursework Example

of Paper] [School] Number] August 30, Concerns in Australian Public Health It has been d that Australia has one of the most quality public health systems in the world and that Australian citizens enjoy a much higher standard of care than many countries in the world today. It stands to reason then, that there would be fewer errors in care in this country than others, but this is an area in which there have been numerous examples to the contrary in recent years. Why then are the errors in patient care becoming a problem for a country with such a good public health system. The answer to that question is complicated, but the base of the problem and the answer lie in a major demographic shift within the country and a lack of trained staff in areas where they are needed. Changing Demographics in Australia and Effects Peter Garling, in his 2008 Inquiry report on healthcare in Australia states that there are, “increasing numbers of elderly patients with complex, chronic conditions which require longer stays in hospital and more specialist teams to treat them. The young also are presenting to public hospitals in greater numbers than was anticipated, especially to the Emergency Departments. Of them, a significant proportion may have mental health problems along with drug and alcohol dependence” (Garling, 2008). This poses an increasing problem to the healthcare industry in Australia because of the demands on services and because there is a need for different types of services in larger numbers than has been there in previous years. Bruce Armstrong and his colleagues also mention the ageing population of the country as a concerning factor. They believe that with the increasing numbers of aging patients, the system is challenged with longer stays in hospital and the need for more specialists for treatment. There are also huge problems related to young people who are coming to the emergency room with drug and alcohol issues. All of these issues affect the overall healthcare system and cause major issues. Armstrong, Gillespie, Leeder etal (2007) feel that much of this problem is related to the fact that Australians are living to the age of 73 which is about 10 years longer than in than in the past which also means they will have more chronic diseases for the system to deal with when they come. This increasing population of the elderly creates a need for more doctors to deal with the geriatric field. There is also the concern that because people are living longer there is an issue of the chronic diseases that come with age and the costs that are associated with that. Over time, it becomes more of a financial burden to care for an elderly citizen who has several chronic diseases as opposed to a middle aged or younger person who may have illnesses, but are not a patient that needs almost constant partial to full-time care. Garling (2008) estimates that the population of Australia that is over the age of 65 and, therefore, make up a large portion of those with chronic diseases caused by age is at 45%. In addition to this section of the population utilizing public care and hospitals more there is the amount of these citizens that will be utilizing care homes and assisted living homes during this period of their lives. This, too, puts a strain on the ability of the public health system to provide care because of the large amount of citizens that need this type of care. It also puts a strain on funding as it was shown in the 2003 budge. There has been a needed increase in spending over the last 30 years of 1.7 to 4.3% (Anonymous, 2003). In order to address the problem there needs to be an emphasis on preventative care and health education to help the ageing population understand how to self manage some of their conditions and how to prevent them when possible. For example, the Department of Health in the state of Victoria, in conjunction with the better health channel produces information for the elderly on how to prevent falls. Avoiding falls is important as greater than 50% of patients in these age groups that fall end up with chronic care in a nursing. home. They recommend that avoiding falls includes improving balance, strength and flexibility, and wearing shoes that are not only comfortable but safe (State of Victoria, 2010). This type of information, when disseminated by general practitioners or geriatric doctors, can help the older population with staying in better shape and healthier in order to live a longer life less fraught with disease and chronic pain. With the right training and classes, older citizens can live lives that cause less of a burden on public health and hospitals. Providing Doctors for Rural Areas Of course, demographic changes do not only mean a change in the population that is being served, as with the example of more elderly, but also a shift in where and how people are accessing services when it comes to public health. Garling (2008) points out “the skilled workforce is not evenly divided amongst the population”. There seems to be a concern that there is a divide between where hospitals are and where good practitioners are and where people are able to access services. Steven Milgate wrote a report for the Australian Doctors Fund that detailed a shortage of doctors in rural Australia. Most countries today are dealing with the fact that there are too few rural physicians. This includes countries like the United States and China among many. (Milgate, 2008). This is a problem that is difficult to address as most physicians want to practice in an urban area due to the likelihood of having a better income. Australia believes that all Australians should have equal access to health care but that is difficult to provide when there are not enough practitioners (Milgate, 2008). Attracting physicians to a rural area is not easy, however, having the whole town involved sometimes makes a difference. Assurance of income and challenge also being important. Not every physician is looking for higher income but to be a part of a community and this happens much more easily if the towns people are involved in the recruitment. Physicians continually deal with other issues as well, including practice guidelines that are not up to date, insurance costs, moving to a new area, relocating a family and starting a new business. The more a town is willing to help deal with some of these issue, the more likely, they are to recruit the physician they are looking for. The attitude of the local health authorities and the power to run those facilities well must be passed to the recruited physicians. Help with housing and setting up the business as well as helping the physician get his family relocated will help enormously. The attitude of existing General Practitioners and Specialists in the town is also important. What complimentary skills do they want from a new colleague? What is their economic viability? (Milgate, 1999). The other issue is that family practitioners need an easy referral source that they can refer patients to. Providing Continuing Quality in Doctors and Nursing Staff The other major area of concern when it comes to public health and providing quality care is the fact that as the population ages this country faces losing a large population of its trained senior nurses and doctors to retirement without having a proper replacement workforce. Peter Garling, in his Inquiry shows that in the next 5-10 years there could be a crisis when it comes to having properly trained workers in public health, When practitioners such as general practitioners are needed the most in an area, yet rewards or higher Medicare schedules are given to specialty physicians, it is quite difficult to keep general practitioners. Further, the Commonwealth discouraged the entry of new physicians into the workforce in the 1990s. Overall, the caused a situation in which the shortage of physicians may not right itself for several years. This, of course is also true of nursing throughout the world. 22% of the entire profession in NSW will qualify for retirement in 2011 (Garling, 2008) which was 3 years away when Garling wrote his work but is now next year. Senior nurses are leaving the stage with only junior nurses, who are less experienced, left to care for patients. These numbers are problematic and need to be addressed. As the ageing population grows, it is going to become more and more important to have qualified nurses and doctors in general practice and geriatrics and if the medical schools are not preparing these doctors or too many are choosing to work as proceduralists then there will be a major shortage. Catherine Joyce also found in her study that there is going to be a shortage of general practitioners in the coming years, “Few data are available about retirement rates, but the approach of retirement age for the “baby boomer” generation of doctors is another likely downward pressure on medical workforce supply. Additionally, increasing opportunities, and requirements, for medical practitioners to carry out non-clinical activities, such as management, administration, research, continuing education, and supervision, reduce the effective supply for direct provision of clinical services. The general practice (GP) workforce has been a particular concern, with perceived shortages that seem set to continue unless steps are taken to address this issue” (Joyce, McNeill, and Stoelwinder, 2006). When McNeill made this statement, there were 4 years to that retirement load and now the expectation for next year is even greater. In order to keep the shortage of doctors and other medical professionals from affecting the health care of the Australian citizenry it is important to make some changes to how the system is run and how medical staff deal with patients. Garling suggests in his Inquiry that, doctors, nurses, and allied health professional all need to replace the old system, essentially with a system that is better formulated and requires fewer professionals. His idea is that no one person would be responsible for the patients care but a large collaborative effort from many people to see the patient is cared for. His theory also brings us back to the old argument about the separation in duties and responsibilities between physicians and nurses. To win this battle, it will require breaking down those walls and looking at a new system. (Garling, 2008). These suggestions will allow for there to be a further continuity of care within the healthcare industry because there will be less rigid boundaries between what a doctor can do for a patient and what a nurse is able to do for a patient. Gorman and Brooks also suggest several ways in which the shortage of qualified doctors in Australia can be solved. These researchers suggest that there should be a high promotion of the field of general practice. They state, “North American data show that for every extra general practitioner per 10 000 population, there is a 9% decrease in mortality among people who have a myocardial infarction; by contrast, there is a 2% increase in mortality after a myocardial infarction for every additional specialist” (Brooks &Gorman, 2009). They also state that it is important for there to be a general agreement in what a doctor’s role should be and that the doctor and nurses need to be able to adapt to the situation that they are in. Conclusion There are many challenges facing the public health system in Australia today. From changing demographics to a possible upcoming shortage of doctors in areas of need, if these problems are not faced and solved then the public health system in Australia could falter. The quality of care within the Australian public health sector is among the best in the world, but in order for that to continue there needs to be a shift in how patients are treated, what kind of care is being provided and where it is being provided. The country needs to provide incentives to doctors willing to practice in rural areas and become general practitioners and there needs to be more of an emphasis on preventative care and quality care for the ageing population. References Armstrong, B, Gillespie, J, Leeder, S, Rubin, G, & Russell, L. (2007). Challenges in health and health care for Australia. Electronic Medical Journal of Australia, 187(9), Retrieved from http://www.mja.com.au/public/issues/187_09_051107/arm11047_fm.html Better Health Channel, Initials. State of Victoria, Department of Health. (2010). Falls prevention for older people Retrieved from http://www.betterhealth.vic.gov.au/bhcv2/bhcpdf.nsf/ByPDF/Falls_prevention_for_older_people/$File/Falls_prevention_for_older_people.pdf Brooks, P, & Gorman, D. (2009). On solutions to the shortage of doctors in Australia and New Zealand. Electronic Medical Journal of Australia, 190(3), Retrieved from http://www.mja.com.au/public/issues/190_03_020209/gor10984_fm.html Commonwealth of Australia, Initials. Attorney Generals Department, Budget Department. (2002). Part iii: projections for spending and revenue Retrieved from http://www.budget.gov.au/2002-03/bp5/html/05_BP5Part3.html#P17_1350 Dwyer, J. (2004). Australian health system restructuring – what problem is being solved?. Australia and New Zealand Health Policy, 1(6), Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC544964/pdf/1743-8462-1-6.pdf doi: 10.1186/1743-8462-1-6 Garling, P. (2008). Final report of the special commission of inquiry: acute care in nsw public hospitals. Retrieved from http://healthactionplan.nsw.gov.au/files/garling-report/E_Overview.pdf Joyce, C, McNeill, J, & Stoelwinder, J. (2006). More doctors, but not enough: Australian medical workforce supply 2001–2012. Electronic Medical Journal of Australia, 184(9), Retrieved from http://www.mja.com.au/public/issues/184_09_010506/joy10149 Milgate, S. (1999, August). Shortage of rural doctors in Australia (and what we can do about it, if anything?). Australian Doctors Fund, Retrieved from http://www.adf.com.au/archive.php?doc_id=70 Read More