patient safety

The Medical Journal of Australia has published an article which looks at the devastating impact of population growth on public hospitals in Australia, as well as the more general impact of increased urbanisation, urban sprawl, and the reduced 'walkability' of neighbourhoods.

Here is an extract focusing on the problems public hospitals are already having coping with the demands of the current population.

"The Garling inquiry concluded in 2008 that the New South Wales health system is in a state of crisis.[13] This finding also applies to the rest of the states, with the possible exception of Victoria.[14]

An independent analysis by the Australian Medical Association has concluded that Australian public hospitals are dysfunctional, operating at full or above-full capacity, and urgently in need of increased capital funding. An important finding was that major metropolitan teaching hospitals operate on a bed occupancy rate of 95% or above. The report noted that hospital overcrowding was the most serious cause of reduced patient safety.[15]

It is clear that, even at Australia’s current population ...[*16A] the public health system is struggling to cope with demand. Changes will be required to deal with a vastly increased, yet still ageing, population and the attendant multiple comorbidities, many attributable to increased urbanisation.

Practical measures might include disinvestment (reallocating health resources from existing practices, procedures, technologies, and pharmaceuticals that do not deliver much health gain for their cost); investing in prevention; increasing the health workforce; and emphasising community health. Other measures might include increasing the role of practice nurses and expanding the role of pharmacists.

The increasing pressure on health services as a result of increased immigration might provide further motivation for a move to a single level of funding, with the federal government taking over responsibility for hospitals from the states. At the very least, this might end the “blame game” and cost-shifting that currently blights the system.

In his 2004 documentary Super size me, Morgan Spurlock suffered severe adverse health consequences after a 30-day period of eating super-sized meals at McDonald’s.16 Prime Minister Rudd’s vision of a super-sized Australia, while it might have some short-term economic benefits, will put further strain on the health system.

The plan to dramatically increase the population of Australia has to be debated and critically evaluated, and a population policy must be developed. In particular, health care professionals must engage with the federal government to ensure that it commits to and delivers on comprehensive national health and hospital reform, matching its appetite for unfettered, economically expedient migration to this country.

If this is not done, we — the citizens of a “big Australia” — will all, like Spurlock, suffer the damaging health consequences of super sizing."

NOTES

[13] Garling P. Final report of the Special Commission of Inquiry: acute care services in NSW public hospitals. Sydney: New South Wales Government, 2008. http://www.lawlink.nsw.gov.au/lawlink/Special_Projects/ll_splprojects.nsf/pages/acsi_finalreport (accessed Aug 2009).
[14] Penington DG. Does the National Health and Hospitals Reform Commission have a real answer for public hospitals? Med J Aust 2009; 191: 446-447.
[15] Australian Medical Association. AMA public hospital report card 2009: an AMA analysis of Australia’s public hospital system. http://www.ama.com.au/node/5030 (accessed Mar 2010).
[16] Gregory AT. A counterweight to fast-food advertising [film review]. Med J Aust 2004; 180: 590.
[*16A] The author, writing at the end of 2009, underestimates Australia's population by about 2 million people, so we have left this number out. Australia's population was estimated by the Australian Bureau of Statistics (ABS) to be 22,306,143 on 13 April 2010 at 05:45:22 AM (Canberra time). Refer to the ABS population clock here: hhttp://www.abs.gov.au/ausstats/abs%40.nsf/94713ad445ff1425ca25682000192af2/1647509ef7e25faaca2568a900154b63?OpenDocument

Source

Deborah Pelser, "Super size me: is a big Australia good for our health?"