adverse events

Jan 31, 2010

5 comments

Tim Mendham, executive officer of the Australian Skeptics, writes:

“One of the poster boys of the global anti-vaccination movement, Dr Andrew Wakefield, has been found guilty of being dishonest, irresponsible and misleading, with the possibility of being struck off the medical register.

Wakefield was a senior lecturer in the Departments of Medicine and Histopathology at the Royal Free Hospital and a reader in experimental gastroenterology. He was an honorary consultant in experimental Gastroenterology with a stipulation in his contract that he had no involvement in the clinical management of patients.

Continue reading “The Skeptics report on Wakefield findings”

health financing and costs

Jan 31, 2010

5 comments

The Australian Society of Ophthalmologists is claiming that its deal with the Feds over cuts to the cataract surgery rebate is a victory for patients.

Croakey is particularly taken by the line in their media statement that says: “The
 ASO 
has 
always
 argued 
that
 the
 interests 
of
 patients
 should 
be
 the 
primary 
consideration
”.

But of course!  (Naturally, Croakey does believe everything that she reads.)

The Consumers Health Forum, however, has quite a different take on the whole issue, arguing that the ophthalmologists and the medical colleges more broadly may ultimately prove to be the losers of what has been “an exploitative industrial campaign”.

Executive director Carol Bennett, who has previously written for Croakey on this issue, writes:

Continue reading “Who are the real losers in the cataract surgery campaign?”

health workforce

Jan 29, 2010

5 comments

Today in Ceduna, Minister Warren Snowdon launched a new national association for Aboriginal Health Workers. This report estimates there are more than 1,500 in the country.

The question I have is: why has it taken so long?

It is not an idle or facetious question. I’d really appreciate any insights you may have, whether micro or macro…

Meanwhile, those wanting to find out more about joining the association, should look here.

Update (2nd Feb)

Dr Sue Page, of the Northern Rivers University Department of Rural Health, has sent in some relevant background:

“Largely because they are low income employees and small in number in any one employment field so nobody “owns” their issues.

However first state based organisation was registered nearly 15 years ago, and the process quickly became national which lead to the push for national competency standards to be developed. Note the new label drops use of the name “professional” which likely suits the NSW agenda of having them focus community education strategies rather than clinical service delivery. In NT they have been registered vaccination providers for years and years.

There is more info here.

The competency standards stuff starts early 1990s in most states, from 2002 at national level, as per this presentation and also here.




global health

Jan 29, 2010

5 comments

Australian Medical Association

Jan 29, 2010

5 comments

The World Health Organization is moving towards taking some action on the flow of health professionals from poor to rich countries. It is likely that Australia is one of its targets, argues health economist Professor Gavin Mooney.

He writes:

Continue reading “WHO moving towards stemming flow of doctors from poor to rich countries”

conflicts of interest

Jan 28, 2010

5 comments

As previously reported at Croakey, the World Health Organisation is facing some awkward questions in Europe regarding the pharmaceutical industry’s role in the pandemic influenza response, and here is the latest snippet in an issue which is likely to continue to hit the headlines.

Professor Robert Booy, a paediatrician and infectious diseases expert from the Children’s Hospital at Westmead, Sydney, argues below that focusing on such concerns risks obscuring the bigger picture, including the potential public health benefits of vaccination. He writes:

Continue reading “Why I have been vaccinated against pandemic influenza: an expert’s account”

illicit drugs

Jan 28, 2010

5 comments

health financing and costs

Jan 27, 2010

5 comments

If the Government takes a close look at the health component of the latest CPI figures, there are some clear lessons for policy, says Ian McAuley, a Centre for Policy Development Fellow and lecturer in Public Sector Finance at the University of Canberra. He writes:

“The movement in the CPI for the December quarter was 0.5 percent. Some media commentators picked up the fall in the health component, which dropped almost one percent in the quarter. If health had been excluded, the quarterly rise in the CPI would have been 0.6 percent.

This does not mean the Prime Minister’s initiatives to improve productivity in the sector have had a stunning early success.

Continue reading “What do the CPI figures really say about health?”

Australian Medical Association

Jan 27, 2010

5 comments

Health economist Gavin Mooney has two offerings for Croakey readers.

For those with an interest in citizen’s juries and their potential for informing health policy and related decisions, he has just released A Handbook on Citizens’ Juries, which sets out their pros and cons, how to run them, and gives some examples of their use in Australia. It is freely available here.

Mooney has also taken up the previous Croakey post on fee for service, and suggests that citizen’s juries may be able to help inform policy about remuneration systems. After all, if we don’t know what the community really wants from GPs, how can we know what is the most useful way of paying them?

Mooney writes:

Continue reading “A freebie book on citizen’s juries, and more debate about how best to pay doctors”

health financing and costs

Jan 22, 2010

5 comments

Has fee-for-service medicine and healthcare more broadly passed its use by date?

“Yes and no” is the suggestion of this brief report from The Canadian Health Services Research Foundation, published as part of its myth-busting series.

The commonly held belief that most doctors prefer fee-for-service is a myth, it says. While the report is framed very much within the Canadian context, many of its arguments sound very familiar.

In fact, I’ve spent much of the morning on the phone interviewing various people about the barriers to recruiting doctors into rural and remote areas, and more than a few nominated the fee-for-service system as unhelpful.

The report doesn’t totally can fee-for-service, however. The main point is that flexible systems are needed to accommodate various situations and needs – not a one-size-fit-all approach. And isn’t that a useful point, more broadly…

Here is the conclusion:

“The modern physician is moving toward an alternate form of payment plan. However, it would be premature to sound the death knell of fee-for-service; when respondents to the 2007 National Physician Survey were asked to define their ideal blended payment plan, 82% included a fee-for-service component. Some payers require fee-for-service “shadow billing” in order to monitor changes in cost and service provision between the fee-for-service model and newer, alternative models of payment.

A decade-old green paper from the College of Family Physicians of Canada argues that flexibility in payment models is imperative: “A one-size-fits-all approach is a straightjacket for both the patient and the physician.” Blended systems offer a range of payment and policy options, each of which will have varying attractiveness to physicians, politicians and patients. The challenge is to determine which models deliver the greatest overall benefits – to patients, taxpayers and healthcare providers.”

I’m not sure that we’ve really had a useful public debate about this issue in Australia. My sense, and maybe I’m wrong, is that it’s been kept carefully to one side during the general health reform debate. Too hot to handle, perhaps?

child health

Jan 22, 2010

5 comments

Now that the summer lull is ending, it’s time to get back to the big issue for the year ahead: health reform. If you ever need an example of why health reform is needed, and why it’s so hard to achieve, look no further than mental health.

Professor Alan Rosen, a Sydney psychiatrist and regular contributor to Croakey (see this recent piece analysing health reform proposals, for example), writes:

Continue reading “Mental health reform part 1: why we need a Mental Health Commission”

adverse events

Jan 21, 2010

5 comments

Further to the posts below on the homebirth study, the AMA has sought right of reply.

Dr Andrew Pesce, for those who haven’t been following the story thus far, is the president of the AMA (which opposes homebirth), an obestetrician and gynaecologist, one of the reviewers of the new study, and also the author of the MJA editorial on the study.

He writes:

Continue reading “The AMA says we are “shooting the messenger” re homebirth critique”

Following yesterday’s Crikey and Croakey pieces on the homebirth study which has been hitting the headlines, I thought it only fair to ask the editor of the Medical Journal of Australia, Dr Martin Van Der Weyden, for comment.

I had raised concerns about the MJA (which is the Journal of the AMA) asking the AMA president, Dr Andrew Pesce, to do its editorial on the study, given the AMA’s opposition to homebirth and the heated politics of maternity services reform.

Below are the questions I put to him by email and in subsequent conversations, and his responses.
Continue reading “Medical Journal of Australia editor responds to homebirth study concerns”

adverse events

Jan 20, 2010

5 comments

Even if you’ve had only half an ear or eye on the media in recent days, you would have heard of a new study, published in the current edition of the Medical Journal of Australia showing that babies are seven times more likely to die during home births”.

The most horrifying aspect of the study is the way it’s been reported by the media and promoted by sections of the medical profession, and I’ve written more about this in the Crikey bulletin today.

Associate Professor Hannah Dahlen, Vice President of the Australian College of Midwives, and an academic at the University of Western Sydney, and Professor Caroline Homer, Professor of Midwifery at the University of Technology Sydney, also had a critical look at the study and the way its findings are being portrayed.

Continue reading “More critique of the homebirth study and its reporting by the media”

public health

Jan 20, 2010

5 comments

In the wake of widespread concern about carnage on the roads, Croakey recently put out a plea to readers: what are some evidence-based suggestions for improving road safety and reducing the toll? And are these being adequately and effectively implemented across the various jurisdictions?

Margo Saunders, a public health policy consultant in Canberra, took up the challenge.

First, she reframed my questions into: what can road safety learn from public health?

And then she provided plenty of answers, as you will discover below:

Continue reading “Why is public health missing from the road safety debate?”

Australian Medical Association

Jan 19, 2010

5 comments

The AMA has been a critic of the Federal Government’s so-called “10-year moratorium”, which helps plug workforce gaps with overseas trained doctors, for some time.

Yesterday the AMA issued this statement, raising concerns about the outrageous problems these doctors and their families face in accessing healthcare and other services, amongst other things. It garnered this nice big splash in the SMH today, under the headline, AMA ends support for bush doctor rule.

But Dr Ian Cameron, CEO of the NSW Rural Doctors Network, says the issues are far more complex than the AMA is allowing, and has some other suggestions for tackling rural doctor shortages.  He writes (and please note the update at the bottom with some amendments):

Continue reading “Injecting some real solutions into the debate about overseas doctors and rural workforce shortages”

Hospitals

Jan 18, 2010

5 comments

Some more pieces in the swine flu puzzle appear in today’s edition of the Medical Journal of Australia (some of the articles were previously rapid online publications).

When you put them together, the impression is that there are many more pieces still missing. The overall pandemic picture is incomplete, highlighting many gaps in knowledge – and the need for a thorough review of our response.

There are plenty of suggestions for policy revision, for eg around border control measures, testing and the need to better incorporate multidisciplinary prespectives in planning.

Here is a summary of the papers:

Continue reading “Some more pieces in the swine flu puzzle, but the overall picture is still lacking”

health workforce

Jan 16, 2010

5 comments

Food

Jan 14, 2010

5 comments

As recently reported on Croakey, a New York City initiative to tackle salty foods has drawn admiration and longing from some public health campaigners in Australia.

Now our North American correspondent, Dr Lesley Russell, reports that the NYC Mayor, Michael Bloomberg, is gaining something of a reputation as a public health crusader. She writes:

Continue reading “Michael Bloomberg: the crusader for public health?”