policy

Dec 21, 2010

A comprehensive look at what we think of our health system

Last month, the Menzies Centre for Health Policy released a health survey where they teamed up with

Possum Comitatus — Editor of Pollytics

Possum Comitatus

Editor of Pollytics

Last month, the Menzies Centre for Health Policy released a health survey where they teamed up with The Nous Group to measure Australian perceptions of our health system. It was a telephone poll with a sample of 1201, giving us an MoE that maxes out around the 3% mark. A fairly broad range of questions were asked, from the way we use the health system through to what we think of it’s quality – right through to our views on  health reform issues generally.

A number of the questions asked this year in the survey were also asked in a previous survey undertaken in 2008 by the Menzies Centre – so we can see if Australian opinion has changed on a few of these over the last couple of years.

First up, respondents were asked to describe their own health – and we’ll break it down by education attainment:

ownhealth1

ownhealth2

As a whole, nothing has really changed since 2008, with a slight majority still classifying their health as very good to excellent. On the breakdowns however, it was interesting that University grads or higher had the best self-perceived health, while those with trade qualifications or a maximum year 10 education had the worst self-perception on their own health. We know that as a general case, education levels and a broad range of actual health outcomes moderately correlate – so it’s interesting to see that education levels also correlate with the self-perception of ones health as well.

On the age breakdowns, it’s pretty much what we’d expect, with Under 25’s having a “very good to excellent” response of 68%, with each subsequent cohort having that proportion decrease until the Over 65’s come in at 44%.

The next question looked at what parts of the health system we’ve used over the past 12 months:

healthuse1

Again, the numbers were pretty stable over the last 2 years – with only ‘seeing a medical specialist’ being the category most likely to have had movement (up 6% in 2 years – though not quite a statistically significant movement). What it does give us though, is some inkling of just how heavily our health system is used by the broader population. But what do we think of our health system?

Fortuitously, this question was asked with three available responses:

healthsystemview1

A majority believed that we have some good parts but fundamental changes need to be made. Yet, over the last two years, the big change in public opinion has been in the number of us that believe that the system as a whole works well, with only minor changes needed to make it work better – jumping 9 points from our 2008 views and coming mostly at the expense of ‘good, but fundamental changes are needed’. Also interesting is that for all the horror stories in the press over the health system, only 14% of us believe it needs to be completely rebuilt.

A follow-up question was asked here, getting respondents to nominate the areas which they have most concern about:

healthssystemview2

Access is by far and away the area which is causing the most grief.

When it comes to our expectations of the health system should we ever become seriously ill, they actually turn out pretty positive – with only health care affordability being slightly problematic, which we can see with the next question:

expectedcare1

If we look at the cross-tabs here and have a squiz at how it pans out by self-identified health status: expectedcare2

…what we see is that those with poorer health have lower expectations of our health care system across the board than those of us that see our health as “very good to excellent”. Also worth noting is that on the age cross-tabs, it is the 65 and over cohort that has the highest ratings of all age groups for each of the four questions.

When asked about broad satisfaction levels with various types of medical practitioners, the results came in as:

healthsatisfaction1

Public hospitals and aged care/nursing homes are the only two areas which don’t have a majority of the population being satisfied with the quality of the services they provide. Everything else enjoys fairly large to huge majorities.

One of the problems that are most regularly mentioned with our health system is the front entrance – GPs and the time it takes to see them.

GPtime1

One of the big divides here is between capital cities and the rest of Australia. 56% of capital city respondents said that the last time they made an appointment with a GP they got in on the same day, compared to only 33% for non-capital city respondents. This gives a pretty good insight into why GP super clinics will become a seriously important piece of regional health architecture!

On a related note, a further question was asked about individual attachment to a given GP and/or GP practice:

doctorattatch1

Two thirds of the public always see the same doctor. When we run the cross tabs between these last two questions, we get:

timeexpectation1

Which sort of points out the obvious – those who have no attachment to a particular GP or clinic, can shop around and get seen earlier. However, when it comes to seeing a GP outside of business hours, the opposite becomes the case – where those who always see the same GP or go to the same GP practice experience a much higher ease of access to after hours GP access. 41% of people who go to different doctors and practices found accessing a GP outside of business hours “very difficult” compared to only 23% of those that always see the same doctor. You can see this additional result in the full report.

The other two questions worth looking at are about health reform. First up, a generically worded, non-partisan question on the Federal governments health reform program with the states.

healthpolicy1

What we see is fairly significant support – 76% for to 9% against. Yet, if you ask this question a different way, with a more partisan angle, that support would start to drop dramatically. It’s how political parties of all persuasions can play vacuous political games with major policy areas – many of their supporters will simply turn their brains off and do as they’re told.

The other reform question was on nurses taking over some of the minor roles that GPs currently undertake.

nurseclinics1

Again, big generic support for this idea. Usually, we see resistance to nurses being medical practitioners among the elderly – many of whom have a strong, almost institutionalised view of the role of doctors in not only our health system, but in society generally. Here is no exception.

If we break run the cross-tabs along age cohorts, what see is that the 65 and older group start to drop off significantly in support levels.

nurseclinics2

Although, still holding a majority view on nurses having an expanded role.

The Menzies Centre health survey is actually much larger than what we’ve covered here and has a dedicated section on aged care. It’s worth downloading the entire report if you’re interested in Australian health issues.

32 comments

Leave a comment

32 thoughts on “A comprehensive look at what we think of our health system

  1. joelandrew80

    In my experience of the UK system, the private system was far more customer orientated, while the state system was certainly more patient orientated. This, in practice, meant you were fine saving fuss and bother plus long waiting times going private for minor surgery, but if your problem was serious, the state system was the far safer option, without even considering the costs.
    In the private system you had a room of your own, your consultant(but only your consultanr) popping in when it was convenient, a nurse on tap when you were “with it” enough to press the right button. You also got quite decent food, again if you were well enough to appreciate it.
    In the public system, you were in a mixed ward, right next to the sister in charge while you were in trouble, slowly moving towards the back of the ward as you recovered. Little privacy, but a lot more sympathy than the private system. Your consultant, plus your GP plus any number of young doctors were all keeping a watchful eye on me when I was in that situation.
    I would never risk a private hospital for anything other than a minor complai

    house designs

  2. Jenny Haines

    This survey is very useful as it records citizens perceptions of the health system as opposed to the realities, but as a health system worker, the result that showed that 71% were satisfied with the care in private hospitals worries me. As several bloggers have recorded if you want safer, patient oriented care, the public hospital is for you. If you want consumer based care, the private hospital is for you, as private hospitals are very much businesses, with the business model of care. Everything is costed and claimed from the consumer. Services are supplied based on minimum cost, including nursing services, which quite possibly means that the nurse that is looking after you is an Assistant in Nursing, with maybe a TAFE Certificate, and not a university trained Registered Nurse. Private hospitals operate on the presumption that the doctor is always right. God help the conscientious nurse who questions a doctor’s orders, even though that is what they are professionally bound to do, to prevent medical mistakes and misadventures. And the back up if things go wrong is not there in private hospitals. I have worked in private hospitals where the only doctor available is a locum who can’t even write a script for Panadol. Thank god the nurses knew what they were doing!! This was in the days of all RN staff. If things go wrong, the policy and practice of most private hospitals is to ship the patient out to the nearest public hospital pronto, so that any adverse outcome appears on the public hospitals statistics, not theirs. And if you have a complaint about a private hospital, where to you go? There is no private hospital ombudsman, but there should be. Beware.

  3. kerneels

    In my experience of the UK system, the private system was far more customer orientated, while the state system was certainly more patient orientated. This, in practice, meant you were fine saving fuss and bother plus long waiting times going private for minor surgery, but if your problem was serious, the state system was the far safer option, without even considering the costs.
    In the private system you had a room of your own, your consultant(but only your consultanr) popping in when it was convenient, a nurse on tap when you were “with it” enough to press the right button. You also got quite decent food, again if you were well enough to appreciate it.
    In the public system, you were in a mixed ward, right next to the sister in charge while you were in trouble, slowly moving towards the back of the ward as you recovered. Little privacy, but a lot more sympathy than the private system. Your consultant, plus your GP plus any number of young doctors were all keeping a watchful eye on me when I was in that situation.
    I would never risk a private hospital for anything other than a minor complaint.

  4. calyptorhynchus

    Needless to say JamesK and freecountry, most readers of this blog won’t share your views on private versus public healthcare.

  5. rhwombat

    OK JamesKKK, have a look at today’s Lancet (relative Ca rates in Oz), then get back to me on the superiority of the US medical system.

    fc: You don’t have a clue about Oz medical system(s), do you? It is all Federally funded: the GPs by Medicare, the state public services by State Govt from Federal funds, and the private specialist and hospital sector by Medicare reimbursements plus the private premium – which is largely funded by the Medicare Levy supported Health Insurance industry (all but one of which are for-profit organisations). The only real exceptions are the private hospital “hotel” services, and the “gap”, which is the over-standard premium that proceduralists can (and do) charge for complex or specialised operations or care in private practice. The federal government took over the funding under Gough, and are still the only game in town: not even little Johnny or Phoney Tony can rebottle the dreadful socialist equity djinn, however much a Menzian Tory (?ex-) academic wishes it were so. Do you really think that anyone either moves state or votes to change a health system – other than if they can’t get care because they can’t afford it? Dream on, Comrade.

  6. JamesK

    Cancer death rates are even worse in wee bonnie Scutland than Sasanachland……….

    Of course that could be due to other factors to do with Mars bars and lard…………if only the poms had money to fund the necessary research.

    The Scuts can’t even spell or say ‘gaelic’ properly….. let alone ‘good health’……

    Or should that be ‘bottoms up’ in cherrypickers?

  7. freecountry

    To some extent it is possible to measure how highly citizens value their healthcare based on how much they would be willing to pay or give up in order to have it. That’s the so called “economic rationalist” metric.

    In reality, citizens have very little idea how much bang they are getting for their buck, unless they have something to compare it with. If I live in Victoria and friends tell me that health in Queensland is better, then I am more likely to either vote for Queensland-influenced reforms in Victoria, or move to Queensland.

    I might do this without having any understanding of why there is a difference. Better managed hospitals? More doctors and nurses? More sunshine, less stress, eating more bananas? Some things are very difficult to measure, either with money or with formal KPIs, but that doesn’t stop citizens knowing by collective wisdom that there is a difference, and voting with their ballots or voting with their feet.

    If the federal government takes over, choice goes out the window. Then all you’re left with is economic measurements, bureaucratic KPIs, and almost meaningless surveys like the one summarized above.

  8. freecountry

    rhwombat, if you can’t even read posts, I worry about how well you listen to patients. I compared the federal government’s impending takeover of hospitals to the previous takeover of universities and quote “conversion of the tertiary education sector from a first rate national resource into a second rate export business” unquote. Yet you answer me with a diatribe against economic rationalism. So when I said I mistook you for a “rational” mind, I meant exactly that, not “rationalist”.

  9. Chokyi Nyingpo

    Excellent post Poss – was beginning to think you were away until next year!

    My comment relates to the lack of &/or access to GP’s outside the hospital system and in particular multi-disciplinary clinics as a result but i should refrain and will not cast nasturtiums on any hard-working GP (as once a clinic has appeared they quickly cover an entire area).

    i harken back to the days when these ‘clinics’ began to appear (remember past Swans owner Geoffrey Edelsten anyone? – in 1971 Edelsten moved to Sydney and recruited another doctor to work at Walgett and would return using his plane at least once per week. Edelsten then purchased a practice in Coogee. The Coogee practice was followed by practices in Hammondville, Moorebank, Chipping Norton, Georges Hall, Fairfield, Liverpool, Macquarie Fields, Campbelltown and Eastlakes. This was the first time in Australia that a group practice had established multiple locations.)

    Which brings me to my point – i believe you can directly link the downward spiral of access to GP’s to the beginning of these clinics.

    My late father was on Dr Neil Blewett MP committee to establish Medibank and argued (from the RACGP’s position, since replaced as the premium body for GP’s by the AMA) that the country could not and would not be able to afford universal health care paid for by any tax or levy whatsoever – the committee’s views were voted down.

    In the decades since and as clinics became more and more prevalent he also observed that most if not all people who visited them had to explain each and every time what their medical history was (as opposed to a visit to “continuous family doctor” who more often than not knew that your problem today most likely has synergy from either yourself and/or another member of your family).

    He also predicted that insurance costs associated with these “clinic” GP’s would rise exorbitantly and thus flow on to the entire medical profession putting affordable healthcare further at risk. One only has to observe the incredible increase in GP’s asking for an ever increasing barrage of tests which most likely are requested to protect their own arses from law suits if they get their diagnoses incorrect; GP’s of the past knew you and were significantly less likely to ask for tests as both yours and your family’s history were integral.

    During the next 15 years he remained alive it was his constant complaint about healthcare that a federal system constantly tinkered with would continue to slowly eroding patient health.

    Simply, and to summarise, clinics are detrimental to ones health and should be resisted at all costs with the attendant savings therefore put into more training and thus places for GP’s within the community as proper “family doctors”.

    Methinks he has been proven correct, no?

  10. rhwombat

    Ronin: Actually that’s garbage for those of us who work in Australian public hospital system: we are (mostly) salaried, not paid by opinion or procedure (yes, we physicians do get Porsche-envy with respect to our proceduralist colleagues, but we don’t have to gag on the illness-for-fun-and-profit-industry). BTW most of the actual cost of illness is in lost productivity, not direct cost of care. Slainte

  11. ronin8317

    You cannot use pure market forces in medicine. The longer a patient is sick, the more money a doctor will make. There is no monetary incentive to prevent illness or to cure the patient. The doctor simply select the most lucritive treatment regardless that the patient’s health insurance will cover.

  12. rhwombat

    fc: I think that should be rationalist mind. Thanks for the solidarity, tovarich. How about replacing that Federation Star with a proper five-pointer (red or white…your choice)? Slainte.

  13. freecountry

    I beg your pardon, I pitched my comment for a rational mind, and completely misjudged my audience. Good luck with that revolution and be careful with those Molotov cocktails.

  14. rhwombat

    JamesK: That’s Scottish marsupial to you, JamesKKK. I take it that you are aware of the alarming incidence of erectile dysfunction in cherry-pickers?

    freecountry: Illness is not a commodity. It doesn’t follow the economic rationalist faith. Demand will always exceed supply, and policies (other than those which promote equality of access) have little or no effect at the clinical level. It doesn’t matter which management theory (or dogma) is used, it all comes down to how many trained hands are willing to pick up the victims of disease, neglect and age. The private system here is largely a way of keeping the fortunate from having to share experiences with the rest, it doesn’t do much for the chronic illness burden of the country. Investing in health care doesn’t have a product measurable in pieces of silver – not unless you tackle the really important drivers, like the profits made by the alcohol, tobacco and empty calorie industries (and their enablers: advertising, media, “gaming”…I’m looking at you Rupert), which we can’t do because it would be too effective. Howling at the moon over your lost dreaming spires seems pretty trivial to me.

    Slainte

  15. freecountry

    RHWombat: When competition, either between commercial providers or between state jurisdictions, is replaced by central governance (perhaps with regional “implementation” of centralized policies), it’s reasonable to expect a one-off improvement in outcomes due to synergies, economy of scale, etc. What goes undetected is the lost impetus for future long term improvements due to competitive comparisons and innovations which will no longer occur so cannot be measured. You’ll never know what you’re missing in the decades that follow as some policy innovations are missed and others are implemented without allowing control groups for evaluation.

    An example is the amalgamation of universities and conversion of technical colleges in the 1980s, and the subsequent conversion of the tertiary education sector from a first rate national resource into a second rate export business which relies on residency enticements to meet its targets. We’ll never know what would have happened if one or more states continued to run its universities and tech colleges differently, because when Canberra applies a policy it applies it to everything.

  16. JamesK

    Actually cancer survival rates in the US have been shown in multiple studies to be better than in the UK:

    http://www.telegraph.co.uk/news/uknews/1560849/UK-cancer-survival-rate-lowest-in-Europe.html

    Are Irish marsupials conflicted as well as stupid?

  17. rhwombat

    JamesK: Thanks for the informed, non-partisan comment. Hope you have a good time in the US health system. How much do you expect to pay for the privilege?
    Freecountry: from a healthcare system perspective, we live in a system that produces better outcomes (and opinions, despite JamesK’s bullshit poll) than the US for just over half the GDP expenditure, but we are not as good as the French (who are almost entirely socialised) or even the Poms. Federal is no worse than state or local: same bureaucracy, same constraints…same ridiculous analogy with University governance. Slainte.

  18. rhwombat

    Thanks for posting this Poss – it’s very encouraging for those of us who work in the public system. A couple of points:

    In most parts of Australia almost all of the private hospital service is elective, highly selective, discretionary and exclusive (in the sense that they can exclude non-paying patients); 80-100% of public hospital service is via the Emergency Department, unselected, non-discretionary…and we cannot exclude. % Satisfied may not be the same thing in these two different populations.

    PB: “Wastage” is a fairly loaded term: reassurance and the opportunity to intervene to prevent, divert or ameliorate the incipient stroke, infarct, malignancy or mental decompensation makes up quite a lot of my practice in the ED of a (NSW) public hospital, and it is not a drain on resources. There is already an ambulance fee, and it has done nothing to slow the presentation of the genuinely sick and anxious people who put up with crowded, chaotic EDs to access the only certain option for care. I do not have the luxury of admitting the worried well, I have to send them home and follow them up in (public) outpatients. The real problem for us is the “efficiency” of funding only enough nurses (and staffed public beds are the only significant denominator here) to cope with the mean, not the inevitable fluctuations. Economists seem to think that sitting with your feet in the fire and your head in the fridge is comfortable…and that carers having time to talk to their elderly mother (or comment on a blog) is a dangerous inefficiency that will lead to an outbreak of compassion – or possibly even having to talk to their mothers themselves.

    Slainte.

  19. JamesK

    Which seems fair ’nuff….. come to think of it…… seein’ as how the living who vote Democrat are largely braindead…….

  20. JamesK

    True SoulmanZ….. but it was a lefty poll and being dead never prevented corpses voting
    Democrat before…….

  21. SoulmanZ

    JamesK – probably all the ones who were disatisfied were dead or bankrupt, and had no ability to answer a phone poll

  22. freecountry

    Do we really need opinion polls on just what measures government should take to address health care?

    Outcomes, yes, such as perceived quality of care, waiting time, and so on. But predicting the usefulness of nurse-led clinics or a federal takeover of hospitals is beyond the expertise of the general public, including me. (However I would make the general point that when federal government took over universities, there was no longer any way for states to compare different policies and learn from each other).

    Are we living in a representative democracy served by informed advice, or a direct democracy where the majority always knows best?

  23. JamesK

    Thanks for this Poss. Very interesting.

    The overwhelming view apart from low satisfaction with public hospitals is the overall satisfaction levels but only 39% were satisfied with the service in public hospitals whilst 71% were satisfied with the service in private hospitals.

    That difference could though, be as much to do with the nature of the people who have to, or more likely decide to use the public system versus the people who choose to use the private system as to anytime real differences in the two services.

    Interestingly before Obama shoved his so-called healthcare reform down the unwilling throat of the people he supposedly represents there were very similar, if not better satisfaction ratings there on New York Times/CBS polling:

    “Despite their negative assessments of the health care system in general, most Americans are satisfied with the quality of their own health care. Three in four Americans say they are personally satisfied, including 41%: who are very satisfied. Just 18% are dissatisfied. These numbers have changed little over the past two years Satisfaction is even higher among Americans covered by health insurance. Higher-income Americans were more satisfied with the quality of their health care than lower-income Americans, though a majority of Americans of all income levels say they are satisfied. Seniors, those 65 and over, are particularly satisfied.”

    http://www.cbsnews.com/htdocs/pdf/poll_health_care_092409.pdf

  24. PeeBee

    There are some pretty simple measures that could improve the wastage in the public hospital system but they come at a political price. Many patients that role up are not in need of treatment (sometimes called the ‘worrisome well’). The ‘granny dumping’ that occurs at this time of year is a case in point. They have to be accepted and drain the resources. Also related it the cost of people using ambulances as cheap taxis to the hospital.

    The solution worth trying is that the user must pay something. When this was applied to pharmaceuticals (with a corresponding increase in the pension) the wastage was reduced.

  25. Andrew Norton

    The advantages of private hospitals are in prompt admission and getting your own room. Once you get into Australian public hospitals, the medical care itself is usually pretty good,and you are probably better off at one of the major teaching hospitals if you have an unusual or very complex problem.

  26. Andrew Norton

    ” It’s how political parties of all persuasions can play vacuous political games with major policy areas – many of their supporters will simply turn their brains off and do as they’re told.”

    A more charitable interpretation is that few of us have much idea about how to solve complex public policy problems, and so we rely on experts and/or people who we think generally share our values. Following the cue of a political party could be just as reliable as an intuitive response to a reasonable-sounding proposition put by a pollster.

  27. Rod Hagen

    [I can’t imagine 61% of people would be unsatisfied with public hospitals if they had actually been in one.]

    Indeed, SoulmanZ.

    In terms of our own family’s experiences both my mother and my wife, and two of my closest friends, have had excellent experiences with the Austin hospital in melbourne in the course of the last year, both as inpatients and outpatients. On the other hand my mother in law had very negative experiences with two well known private hospitals on the Mornington Peninsular.

    My late father, a dentist with a long involvement with the medical profession (his brother, in fact, was the Dean of Medicine at a major Canadian university) for years used to extoll the virtues of private medicine after some early less that fortunate experiences working for the UK National Health System. In his last years he spent time in both private and public hospitals on Sydney’s northern beaches. He was staggered at how much better he found the public system and completely changed his mind about something that he had been a loud (boring) proselytiser about for years!

  28. SoulmanZ

    I might have missed it, but is there a cross tab on “satisfied with public hospitals” vs “been to hospital in the last year”?

    I can’t imagine 61% of people would be unsatisfied with public hospitals if they had actually been in one. That would be incredibly disheartening, especially when so many are ‘satisfied’ with private hospitals, when in a lot of settings the service is equal if not worse.

    In fact, the 32% who have been in hospital recently is remarkably similar to the 39% who like public hospitals! A confounding of the services by negative opposition campaigns in NSW and QLD?

  29. Rod Hagen

    That’s a fascinating post, Poss. many thanks.

    I’d have to say that my own experiences with public health in Victoria, helping my 90 year old mum with her various problems, has been extremely positive.

  30. Possum Comitatus

    Not that I can see Dio – which is a bit of a shame.

  31. Diogenes

    Poss

    We have a two-tiered hospital system. Did they compare responses of people with private health insurance and those without?

  32. Tweets that mention A comprehensive look at what we think of our health system – Pollytics -- Topsy.com

    […] This post was mentioned on Twitter by Possum Comitatus. Possum Comitatus said: On Pollytics: A comprehensive look at what we think of our health system http://bit.ly/fLz5rz […]

Leave a comment

Share this article with a friend

Just fill out the fields below and we'll send your friend a link to this article along with a message from you.

Your details

Your friend's details

Sending...