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| X-ray showing growth plate fracture, right little finger. |
In the days straight after the federal election, I stood in a doctor's waiting room, with a sad, soon-to-be panicked child. As I looked around the reception area for notices regarding bulk billing eligibility and restrictions, I had the strange realisation that this small regional medical centre did not bulk bill. Not for kids or pensioners. It seemed, not for anyone.
The election had brought Medicare into sharp focus, and here we were, city dwellers, usually with a choice of medical services at our doorstep, at a small town GP, shelling out $80 for a consult. A consult which had been conducted by a nurse, in fact, with the GP doing only a brief pop into the procedure room. $80.
Money wasn't the main focus for me, luckily, but I was aware, in this post-election mess, that for many, such a trip to the doctor for a kid's school holiday injury could break the weekly budget. After the GP, there was the X-ray in a neighbouring town ($90), a return to the GP, and the instruction to 'go to the hospital.' Yes, there was a fracture. It might need surgery, she said, maybe inserting a wire. I looked across at the kid who at this point was looking as if he had been strapped into an electric chair. The private hospital charged $195 just to be admitted by the triage nurse. After a brief wait, and a much appreciated 'complimentary' round of sandwiches and cup of tea, we were seen by an ED physician. Expert opinion, a new, improved plaster cast and a referral, and we were out of there. No surgery, for now. Fracture, heal thyself.
This encounter with the health system got me pondering a recent article about Melbourne parents increasingly choosing to use hospital emergency departments for their childrens' minor ailments, rather than GPs. The article suggested that parents may have lost faith in their GP's capacity to reliably diagnose childrens' illnesses and injuries. In addition, the research suggested that there may be the issue of lack of availability of appointments in some areas. The Royal Children’s Hospital has had a sharp increase in ED use, prompting Professor Gary Freed, whose work is referenced in the article, to say: ‘In a decade, your system will break. It's already fracturing.’
But now I wonder, after my recent experience, how much of this parent behaviour is related more to cost? My 8 hour medical to and fro between GP, X-ray centre, back to GP and then to hospital has left me over $300 out of pocket. As my medico mate said to me 'why didn't you just go to the public hospital? It would have been free.' Um, good question it seems. At the public hospital I'd have received X-rays and access to specialist opinion, all in the one place, at minimal cost but to my patience.
I had chosen to hope there would be no fracture, so the GP seemed the wisest option to start with. We would rule out the likelihood of a broken bone, as other parents might wish to rule out pneumonia, or measles. Personally, I still think it was the right course of action for us, though my credit card took a battering. But, in reality, this amount of money might be the cost of the winter electricity bill, or a kid's birthday party; for some, this would be unthinkable. Freed’s research found in fact that ‘The perceived cost of appointments may be influencing the behaviour of parents seeking care for children with non-urgent conditions.’
Early last Sunday morning, Malcolm Turnbull stood and raged against Labor's 'Mediscare' campaign. A disgraceful 'lie' which had swung voters against the Coalition. Yes, the swing was there, and it may well have been influenced by voter fear and distrust on this issue. As Turnbull conceded, the 'ground was fertile' for this campaign. But it may also be that hefty out-of-pocket medical expenses are not a distant illusion, or a projected threat, but a real life economic reality for some, which no amount of 'jobs and growth' rhetoric would make disappear.
In the climate where Duncan Storrar highlighted that increasing his tax-free threshold would allow him to take his daughters to a movie, whereas the top end wouldn't even notice an extra $5, there is a bunch of voters who may not be able to make the choice to go to the GP when their kid gets sick, again. For those parents 'taking up space' in the ED, they may feel they have a right to be there. Sure, it can be said to be cost shifting between the federal and state governments, but as our government still provides medical care to all, why shouldn't we use it?
For those with the capacity to pay, a school holiday fracture is a costly pain in the arm (or hand, or leg). For those who see that medical services are becoming too expensive to afford, maybe they feel they have the right to expect being given a helping hand. If the trickle down is drying up, why not go direct to the source? And then when the election result comes in, we'll see who can mend this fractured polity.
Edited version first published by The Age, p. 16, 11th July, 2016
Further reading:
Health Services: Patient Experiences in Australia, 2009. Australian Bureau of Statistics
Actual Availability of General Practice Appointments for mildly ill children, Gary L Freed, Amie Bingham, Amy R Allen, Michele Freed, Lena A Sanci and Neil Spike
The election had brought Medicare into sharp focus, and here we were, city dwellers, usually with a choice of medical services at our doorstep, at a small town GP, shelling out $80 for a consult. A consult which had been conducted by a nurse, in fact, with the GP doing only a brief pop into the procedure room. $80.
Money wasn't the main focus for me, luckily, but I was aware, in this post-election mess, that for many, such a trip to the doctor for a kid's school holiday injury could break the weekly budget. After the GP, there was the X-ray in a neighbouring town ($90), a return to the GP, and the instruction to 'go to the hospital.' Yes, there was a fracture. It might need surgery, she said, maybe inserting a wire. I looked across at the kid who at this point was looking as if he had been strapped into an electric chair. The private hospital charged $195 just to be admitted by the triage nurse. After a brief wait, and a much appreciated 'complimentary' round of sandwiches and cup of tea, we were seen by an ED physician. Expert opinion, a new, improved plaster cast and a referral, and we were out of there. No surgery, for now. Fracture, heal thyself.
This encounter with the health system got me pondering a recent article about Melbourne parents increasingly choosing to use hospital emergency departments for their childrens' minor ailments, rather than GPs. The article suggested that parents may have lost faith in their GP's capacity to reliably diagnose childrens' illnesses and injuries. In addition, the research suggested that there may be the issue of lack of availability of appointments in some areas. The Royal Children’s Hospital has had a sharp increase in ED use, prompting Professor Gary Freed, whose work is referenced in the article, to say: ‘In a decade, your system will break. It's already fracturing.’
But now I wonder, after my recent experience, how much of this parent behaviour is related more to cost? My 8 hour medical to and fro between GP, X-ray centre, back to GP and then to hospital has left me over $300 out of pocket. As my medico mate said to me 'why didn't you just go to the public hospital? It would have been free.' Um, good question it seems. At the public hospital I'd have received X-rays and access to specialist opinion, all in the one place, at minimal cost but to my patience.
I had chosen to hope there would be no fracture, so the GP seemed the wisest option to start with. We would rule out the likelihood of a broken bone, as other parents might wish to rule out pneumonia, or measles. Personally, I still think it was the right course of action for us, though my credit card took a battering. But, in reality, this amount of money might be the cost of the winter electricity bill, or a kid's birthday party; for some, this would be unthinkable. Freed’s research found in fact that ‘The perceived cost of appointments may be influencing the behaviour of parents seeking care for children with non-urgent conditions.’
Early last Sunday morning, Malcolm Turnbull stood and raged against Labor's 'Mediscare' campaign. A disgraceful 'lie' which had swung voters against the Coalition. Yes, the swing was there, and it may well have been influenced by voter fear and distrust on this issue. As Turnbull conceded, the 'ground was fertile' for this campaign. But it may also be that hefty out-of-pocket medical expenses are not a distant illusion, or a projected threat, but a real life economic reality for some, which no amount of 'jobs and growth' rhetoric would make disappear.
In the climate where Duncan Storrar highlighted that increasing his tax-free threshold would allow him to take his daughters to a movie, whereas the top end wouldn't even notice an extra $5, there is a bunch of voters who may not be able to make the choice to go to the GP when their kid gets sick, again. For those parents 'taking up space' in the ED, they may feel they have a right to be there. Sure, it can be said to be cost shifting between the federal and state governments, but as our government still provides medical care to all, why shouldn't we use it?
For those with the capacity to pay, a school holiday fracture is a costly pain in the arm (or hand, or leg). For those who see that medical services are becoming too expensive to afford, maybe they feel they have the right to expect being given a helping hand. If the trickle down is drying up, why not go direct to the source? And then when the election result comes in, we'll see who can mend this fractured polity.
Edited version first published by The Age, p. 16, 11th July, 2016
Further reading:
Health Services: Patient Experiences in Australia, 2009. Australian Bureau of Statistics
Actual Availability of General Practice Appointments for mildly ill children, Gary L Freed, Amie Bingham, Amy R Allen, Michele Freed, Lena A Sanci and Neil Spike
(c) Anna Sublet, 2016
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