Monday, December 10, 2007

Health 'care'

I’m not particularly prone to criticize the countries that generously open their doors to a wanker like myself, and even less to sing the praises of my own 'fatherland', but this is worth posting. Clarissa had a bike accident on Saturday (she hit a lamp post) and her toe was badly swollen, so on Sunday afternoon we took a bus to the curiously named Calvary Hospital.

We arrived at 4:10 pm and everything went fine in the emergency room, she was examined, taken straight to X-rays and then told to wait to be called by a doctor. The waiting room was not too packed, the TV was showing a particulary unappropriate show, and a guy lying next to us was in terrible pain with his mother looking after him. Clarissa hadn’t had lunch so I headed to the cafeteria to get her something to snack and a coffee, but it was closed. Apparently Catholics take their Sundays quite seriously here. OK, how about the espresso machine in the corridor? 'Out of order'. Jesus H Christ.

The last bus going back to O’Connor passed at 7 pm, and we were still comfortably sitting there waiting. A little boy came with his parents, holding his arm, covered in blood and crying inconsolably. They told them to take a sit and enjoy the TV show (?). At 8:40 Clarissa was at last called in and the doctor gave his verdict: ‘broken toe’. That’s it, go home, get a good rest and don’t go around hitting lamp posts.

OK, just to put things into context, we are talking about a public hospital in Canberra, the capital of Australia. Some facts about the city:

Population: 325,800
Life expectancy: 82 years
Unemployment rate: 3 %
Annual per capita income: U$S 47,131
Public hospitals: 2
Population per doctor: 383

As compared to Corrientes, the last place where I lived in Argentina, and its second-poorest (!) capital city:

Population: 328,600
Life expectancy: 72 years
Unemployment rate: 6.8 %
Annual per capita income: U$S 3,964
Public hospitals: 5
Population per doctor: 189

I had to go to the public hospital several times there and the maximum waiting time in all cases was 45 minutes.

So, my question here is simple: WHAT THE FUCK???

Addendum: Lu Liang, my Chinese colleague from the lab, lived in Canada for some time, and she commented that the health system there is remarkably substandard, with waiting times of 5 hours or more in the emergency rooms of public hospitals. She even had a friend passing out in a waiting room after an 8-hour delay to see a doctor. The Canadian director Denys Arcand addresses this point in two extraordinary movies: Jésus de Montréal and Les Invasions Barbares. I'd better not get sick if I go to there next year (?).

Seriously, what’s wrong with these absurdly wealthy countries’ health care system?


Leah said...

I had a similar experience at Calvary. I was told that the wait was going to be over 8 hrs. Luckily the nurse was great and said if I could wait till the morning for a xray, the wait would only be 1hr. (which it was) But, I agree the waiting time in the public system is appalling, I sent in a survey and told them so!! 13 yrs of a liberal fed gov? the act gov needs to address these issues as well. Don't talk about NSW healthcare system, its probably worse...

Jose said...

Yep, I agree. Similar expireiences with Lucia and myself.

La Chounie said...

Only meth-heads and drunks go to the hospital emergency rooms. I recommend you go to 24 hour clinic or doctors surgery. The Australian healthcare system is one of the best in the world. The measure of a good healthcare system include indicators such as overall mortality, infant mortality, prevalence of certain diseases etc. I am afraid to say the data speaks for itself. Anectodatal testimonies, although emotive and peachey are really have a history of not being a sound reflection of the overall picure. I would be reticent in allowing anecdotoal testimonies to trump peer-reviewed epidemiological data. The success of the Australian system is due to its efficiency. The US has by far the best medical healthcare on the planet but unffortunately it is hoplessly inefficient, they spend the highest per capita around $4271per person yet this does not translate into improved overall public health. Australia spends around $1700 per person yet enjoys one of the highest standards of public health, only Norway and Iceland are rated higher and both countries spend twice as much as Australia does. So in concluding, it is fallacious to commit to a conclusion based on flimsy and emotive-laden anecdotes. I trust the tone of my arguument is received well and in the spirit of debate. Afterall this is a blog, not a circle-jerk and as such differences of opinion will arise.

La Chounie said...

Agustin, your own data seems to suggest that an increase in the number of hospitals decreases the life expectancy of the population. Can you explain this?

moof said...

I refer you to my recent blog post and the story therein:

Personal experience of mismanagement in the hospitals... More anecdotal evidence for you:

Nov 8th-13th 2006: Waited 3 hrs in an empty waiting room at Calvary, then 8hrs in Emergency for a bed/surgery, then 26 hours for surgery, then 3 days for an orthopaedic surgeon to look at my leg and realise muscles had died in the meantime.

Dec 12th: After being admitted by surgeon, waited 8 hours in emergency for a bed, then a further 8 hours for antibiotics to be administered (which happened only because my surgeon hadn't gone home yet and checked in on me at 11pm)

Jan 12th: They lost my forms and didn't realise I had been booked in for surgery. Called my surgeon on his mobile, who blasted the crap out of them and found me a spot at the top of the queue.

Jan 24th: Another infection. Waited 6 hours in emergency for a bed, 6 hours in a bed for antibiotics.

Agustin said...

Your argument is very well received, that’s the whole idea!

That only meth-heads and drunks go to emergency rooms is funny, but not true.

I was misleading in the post because I didn’t mean to address the ‘health care system’, just emergency attention. Anyway, now that you brought it up, and since you like figures, that Australia’s HC system is one of the best in the world, depends on what you mean by ‘one of the best’. According to World Health Organization it ranks 32nd. And, sorry to say so, it does rank below Saudi Arabia and Morocco. Argentina ranks 75th there.
If you put this list (find it here aside a ranking of per capita income corrected by purchasing power parity (find the list here, a striking fact pops up. Australia ranks here 20th, whereas Argentina ranks 71st. My point is, we have a health care system in accordance to what our wealth and wealth distribution permits, whereas Australia’s health care system lags way (12 positions) behind the money. Anyway, I go back to the first point, I don’t know either Australia’s or Argentina’s health system enough to discuss them. But I do know emergency attention first-hand in Argentina and Brazil very well, and I have talked to many (enough I would say) people about emergency attention here in Canberra. Which, being the capital, I assume to have the higher standards of the country – I may be wrong here, of course.
Further, your correlation number of hospitals and life expectancy could never possibly hold any water. I would go by the fact that per capita income in the 2 cities I compared is 12 times higher in favor of Australia. Also, educational levels are (by landslide I regret to say) higher in Canberra, and that has already been shown to hold a strong correlation to life expectancy, which is quite intuitive anyway.
The post may be emotional but it doesn’t appeal to emotion, so I wouldn’t say it’s fallacious. I would also never make such far-fetched claims without a good survey beforehand, and as said, of all the people I’ve talked to, almost a 100% agreed on the fact that waiting times are preposterous in Australian public hospitals’ waiting rooms. And I’m not even cherry picking and putting forward extreme cases I know.

Finally and however woowooish and PoMo this may sound to you, when it comes down to health I raise an eyebrow at epidemiological ANOVA metanalyses results. That the physical and emotional suffering people can undergo while waiting to see a doctor (and again, I don't mean Clarissa's case here, I just used that to bring the subject up) are not quantifiable doesn’t mean they shouldn’t be taken into account. And my point is, if you have money – as Australia does – and don’t use it to improve the people’s living standards, then what’s it worth?

PS: the 24h clinic appointment costs 80 bucks and we don’t get reimbursement because we don’t have Medicare.

moof said...

Yeah sorry:
Here's my linkywinky:

Only a matter of time

commented on by me

and an emergency nurse at The Canberra Hospital

yay I do HTML

Andrew said...

La Chounie,

What is this 'peer-reviewed epidemiological data' you refer to?

How can the US healthcare system be both 'the best in the world' and also 'hopelessly inefficient'? Isn't one dependent on the other?

How can you advise people not to attend public hospitals (because they're only fit for 'meth-heads and drunks') and then in your next sentence say that Australia's healthcare system is among the best in the world? Haven't you agreed with these accounts of long waiting times and poor service with your advice not to go to public hospitals? If so, where does that leave your argument?

Agustin said...

Moof, if Shaun is right then your case was just a series of unfortunate coincidences.

Of 'permanent' coincidences.

moof said...

It is about chance. Some days, you'll breeze through Accident and Emergency, treated, wrapped and sent off with a sparkle. Other days, when the system is even the slightest bit stressed, things fall apart. It's a classic case of communism in there: The only way to get anywhere is to cheat, because everyone else is doing it too. But the sickest can't cheat.

It IS an Australia-wide problem, but most people who experience it are too old and infirm to do anything about it.

It amazes me that at the last election, while people were campaigning for rights at work, climate action, etc etc, NO lobby group campaigned for health.
Rudd promised 2 billion or a full-scale federal takeover of hospitals.
Can we afford to wait and see what he actually does... And if it works?

La Chounie said...

This is the problem with anecdotal testimonies. Everyone I have spoken to, (except members of this blog) as well as my own experiences, have remarked positively on the efficiency of emergency health care. So where does that leave us? I think we need to look at the bigger picture with health care. Australia has a very high life expectancy, low child mortality, low cancer mortality, low prevalence of diseases such TB, HIV. So the public health care seems to be working pretty well. I know we are moving off subject as you were specifically discussing emergency rooms. But you do not achieve these high figures of public health with a broken health care system. So the implication that the health care system is deficient does not seem to be well founded. Of course there a bound to be horror stories, and Moof, I am very saddened to hear of your ordeal and I hope you have fully recovered. However there are a lot of positive anecdotes that are never heard of, it is just the human thing to do to remember the hits and forget the misses, i am sorry to say.

Agustin, are saying that you do not have any form of health insurance?

La Chounie said...

Andrew, what I was attempting to explain with the American system having both the best and most inefficent system is this. If you have money, you can receive the best treatment available anywhere on the planet. However, the US spends a huge quantity of money on health care, yet there overall public health is not improved, that is why it is inefficeint.

As far as the meth-remark is concerned I was just recalling a memory my sister who told me when she was working at the emergency room at Alfred Hospital in Melbourne that the majority of her patients were drug and alcohol related. Maybe what this forum needs are some testimonies from people who work in the ER, I can assure you it is not an easy job!

moof said...

Testimonies from the ER? Look no furter than

We have good people doing lots of good. But there are too few for a huge and ageing population

Most people will reflect positively on pain being eased. They'll worship their doctors and nurses, even when they don't do anything but smile and put a band-aid on. That's human nature. Hell, I know ;-)
In fact, I'll wager the more distressed they are beforehand, the more positively they'll reflect on the distress being eased.

But Shaun, the misses are increasing every year. It's incontrovertible.
Eg. from ACT Hansard:
"The ACT Health Services Commissioner says there has been a 28 per cent increase in the number of complaints fielded in the first four months of this year—that is, 2006-07."

La Chounie said...

Moof, I come from a family of medicos so my position is likely to be slightly skewed in favour of the medical staff. My own personal experiences in Melbourne has been superb, both emergency room and elective surgery. When I returned from islands back in 96 I had symptoms of malaria. I went to the emergency at the Alfred and was treated in a most remarkably efficient manner, I am still impressed to this day. The most distressing part of the experience was being fingered by an unambiguously gay nurse. I have never been sick or required emergency treatment in Canberra at Calvary, but my housemate had a elective surgery there and I recall him being very positive about the experience. In writing this I will likely now get hit by a car on the way home and will no doubt be waiting hours in the ER. Ho hum...Since I am trying to write a thesis and this argument has the potential to drag on for quite a bit, can we continue this at dinner tomorrow. I believe I am coming around to Frencham for a lamb roast. I hope this new government will allay your perceived/apparent concerns raised in this blog.

moof said...

Interesting. I have not yet met a health care professional in the ACT who isn't distressed about the state of it all. Anyway, merry Christmas.

Mat's mum is in town tomorroz. And then we're off to Sydz.

Leah said...

I know that La chounie has family members in the medical profession and I accept that this is a very demanding, difficult job, and I have the utmost respect for what these professionals do. However, the demands of the job are not really the issue here.

Here's some data from the Federal Government Department of Health and Aging.

Figures compiled recently from 2003-4, show that in the ACT, 100% of Critical Emergency patients, that is Triage Category 1: patients needing life saving resusitation, are treated within accepted emergency times, that is within 2 mins.

However, for patients classed as:
Category 2: Emergency,(imminently life threatening)
Category 3: Urgent, (potentially life threatening) and
Category 4: Semi urgent (potentially serious)

only 59.8 -68.8% (depending on the category) are treated within acceptable triage time limits.

These ACT percentages sit at the time of the data 2003-4 around the national average. Overall the national average of service delivery in Emergency Departments was seen to unacceptable by several benchmarks in the sector. These figures (and others) were the cause recently (10th Dec 2007)for the NSW state government agreeing to deliver on a state health plan to address these prolonged waiting times as well as prolonged waiting times for elective surgery. It is Priority S1 on the healthcare plan, although NSW health care performances were 'seen to be better' than the national average.

Leah said...

oh, I meant to say I don't know whether the state action plan actually means anything will happen. But it has been identified as a problem, which in the fullness of time, at the appropriate juncture, they may address.

Agustin said...

Just one more follow-up on the US. The show there is run by Evangelical Capitalists, who believe the government's role is business, not welfare, not education, not public health. Thus, 42 million US Americans have no medical health insurance whatsoever.

I quote Paul Kurtz now:
"the US, the wealthiest nation in the world, does not have a universal system of health coverage. Here a basic humanistic principle is at stake: the conviction that health care is a human right and that each person is entitled to some coverage."

So, I think that 'if you have money, you can receive the best treatment available anywhere on the planet' and 'having the best health care system' are two quite different claims, even contradictory.

And maybe that's why France ranks #1 and not the US.

La Chounie said...

So the main confusion here is that we are talking about two related but specifically different things. ER room vs the public health of the country. From the half dozen anecdotes it seems like ERs in Canberra specifically Calvary are mismanaged. It is unrealistic to expect 100% straight in and out service, the key is to find a balance and run the hospital effiecently. It is all economics! Hospital administrator only care about the stats I am afraid to say. I am willing to except the balance may not be the best at Calvary, and if this is case it may need fine tuning to restore the balance. It is not practical to have five trauma surgeons on call at $300 an hour to do the same job as one, who would be admittedly be pretty stretched at times. The reasoning is that doctors generally like to be busy and enjoy some time with their faimilies. It lowers morale having them sitting around doing nothing most of the time.

My main main point is this. If the system is so broken, if the system is killing people and causing endless suffering. Why then does Australia enjoy outstanding public health. Why are indicators of public health: life expectancy, child mortality, cancer mortality, heart disease mortality among the best rated in world. Why is life expectancy higher in Canberra,(two hospitals), by a 10 whole years than in Corrientes,(five hospitals). It is not just education beacuse both countries have similar literacy rates. I think an argument could be made that the extra hospitals in Corrientes is taking 10 years of the population. That is 3,000,000 years of life, who is looking out for these people? And just to be clear, I do not know how familiar people are with epidemiological data, but ten years life expectancy in a population is an enormous amount of death and suffering, not mention distress and heartache for the victims families. A classic example of ideology killing people! A holocaust, you might say!

So the question should not be:

"So, my question here is simple: WHAT THE FUCK??? " or "Seriously, what’s wrong with these absurdly wealthy countries’ health care system?"

But why do countries like Argentina continue to follow an ineficient romantic cuban model of healthcare (I do not know if this is the case so excuse me if I am wrong) and not follow a model of healthcare based on the Australia system and try and improve that life expectancy. That is the bottom line, it is all about the big picture. (in my opinion, I am sure other will disagree and they certainly entitled to hold such an opinion)