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Stop repeating cliches about ‘not enough beds’ and start looking at alternatives like startups

 

I commend The Age and the ABC for their recent expose of the 7 11 scams. However when it comes to health, I feel both these media outlets publish shallow stories. It’s time to stop the cliche’s about ‘not enough hospital beds’. And start looking at the wrong care being given to the wrong patient at the wrong time.

Australia is spending 140 billion a year on healthcare, to service a mere 21 million people. Where does all this money go?

Hospital beds (per 1,000 people) in Australia was 3.90 as of 2010.

Out of 189 countries assessed by Index Mundi, Australia rates number 55 for the ratio of hospital beds per patient. The highest is Monaco at 16.5 beds per 1,000 people. The lowest is Mali at 0.1 beds per  1,000 people. The UK is 78 on the list, with three beds per 1,000 people. The USA has the same amount, three beds per 1,000 people. So Australia has more hospital beds per head of population than Britain and America.

Australia’s uncoordinated and inefficient health funding system has been well documented. Government health funding is fragmented across a range of state and federal departments. Private funding is split between private health funds, patients out of pocket costs and some government rebates. None of these public or private funding bodies integrates their data. There are no figures showing a breakdown of how appropriate care is for the patient’s condition, how much it cost to deliver, and how good the outcomes were for the patient.

 

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For decades, reports have been warning that Emergency departments are full of people with minor conditions who could more cheaply be treated in GP clinics. The NSW Daily Telegraph published a story on Emergency departments last year.

    ‘The latest figures reveal almost 200,000 people admitted to emergency rooms in 2011/12 are suffering conditions classified as preventable, while more than 300,000 visits to emergency are for non-urgent or only semi-urgent conditions that could be treated by local GPs… With preventable hospital admissions at record levels, experts put the bill at $900 million… People arriving at emergency departments for non-urgent conditions like earaches or sprained ankles makes up the bulk of all visits to state hospital emergency rooms, according to the Bureau of Health Information, clogging up the system and putting unnecessary strain on hospital resources.’ The Daily Telegraph 2014.

Doctors were quoted as saying that ‘of lot of people visit emergency departments with non-life threatening conditions because it’s free… hospitals are like a “one stop shop” for x-rays, blood tests, and medication.’

An Emergency Department nurse added her story to the comments.

‘I have worked in an Emergency Department for many years.  The reason people access Emergency Departments for less urgent medical reasons is this:  they cannot access a GP on weekends or after hours and if they can, they cannot afford the exorbitant fee which is charged.’ The Daily Telegraph 2014.

GP’s are federally funded. Many say the gap between the cost of running a practice versus the Medicare rebate has grown substantially over the years. Hospitals are state funded and appear to be left picking up the federal government’s health tab.

 

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The other big issue in Emergency departments is end of life patients.

    ‘Emergency departments are increasingly used for patients, whether they are seriously ill as a result of being at the end-of-life… or whether they have a mainly acute and potentially treatable condition… Lack of patient education and medical planning appear to be the problem with some end of life patients showing a lack of understanding of a ‘good death’…. The unfortunate result is often ‘resuscitation and active treatment’ even if it’s not the best option for the patient.’ A Literature Review on Care at the End-of-Life in the Emergency Department

You have to break an elderly person’s ribs doing CPR to understand how aggressive and distressing active medical treatment can be.  I was once involved in doing CPR on an elderly man who arrested in a neurosurgery ward at 2 am in the morning. He had sustained a head injury after he used his pick-up frame to hobble across a major Melbourne freeway in an attempt to commit suicide after living with cancer. He was hit by a car, brought into hospital by ambulance, resuscitated, given a tracheotomy and put on our ward. After his heart had stopped, we did CPR for 19 minutes while complaining to the doctors that this was unfair. The man survived, was sent to ICU and promptly returned to the ward with a ‘Do Not Resuscitate’ status on his record. I still cringe when I think of his painful, undignified death.

It’s not surprising to find out that people who die in hospitals tend to have a lower quality of life compared with those who die at home. And it’s not just the patients who are affected by a bad death. Their families are apparently more likely to develop a mental illness after the distressing hospital death.

Many reports confirm that up to half of all medical costs are incurred during the last 6–12 months of life. But the money is not being well spent.

Between 45% and 70% of Australians have been reported to prefer dying at home. In the US, 80% of people would prefer to die at home. However, most people in the USA, UK, and Australia are now dying in hospitals. A large number of elderly, end of life patients die in Emergency Departments. In many cases, they have been admitted to a hospital knowing that modern medicine has little to offer. I can’t think of a worse place to die that a noisy, hectic, impersonal Public Emergency Department. Then there are private Emergency Departments, charging up to $500 just to be admitted, no rebate on private insurance. How would you like to die stressing out about unexpected out of pocket costs?

So why is The Age doing shallow stories about lack of funding for Emergency Departments? Laziness? Pandering to wealthy sponsors? Pandering to political correctness?

What about a decent story on health startups designed to keep people out of busy Emergency Departments?

Health & Australian site giving advice on topics, conditions and symptoms
Health Engine – search for medical services
MedAdvisor – information on medications
Medical Teleconferencing; ReadyCare, GP2U and HotDoc
PalliAGED, a smart phone app that helps GP’s caring for elderly end of life people in the community. It’s available on the iTunes, Google and Windows store.
Decision Assist is an Australian website that offers advanced care planning resources.
Advanced Care Planning Australia offers assistance with documents for end of life care
Palliverse is a blog bringing together people, ideas and funding for end of life services
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References

Patients waiting for days on emergency trolleys to get into hospital: study. Julia Medew. 21 September 2015.

Patients are clogging up State Hospital Emergency rooms with minor conditions costing tax payers close to 1 billion a year. Alicia Wood. 15th March 2014. Sunday Telegraph.

A Literature Review on Care at the End-of-Life in the Emergency Department. Roberto Forero, Geoff McDonnell, Blanca Gallego, Sally McCarthy, Mohammed Mohsin, Chris Shanley, Frank Formby, and Ken Hillman. Emergency Medicine International, Volume 2012, Article ID 486516, doi:10.1155/2012/486516

 Wikihospitals September 2015