Public Health Systems  (April 2016)

I recently suffered a bicep tendon rupture while doing some impromptu gymnastics.  Subsequently, I ended up in a plaster cast after surgery to reattach the tendon to the bone with a thick suture held in place with a titanium pin.

Thankfully I live in a country where public medicine is accessible and affordable but I thought my experiences with the public health system, at least as it is applied in Australia, could do with some kind of critique. 

The Elite Benefit

The right to good affordable medical care is expected everywhere in the world.   Regardless of country, it is generally still the wealthy or famous who benefit the most from whatever socio-political healthcare policies are in place.  If you are a US citizen your health insurance is only as good as your policy premiums whereas with unlimited funds your policy will be the best money can buy.  Even if that isn’t enough, you can simply cover the cost of special treatment yourself.  Of course, if you are well known, a politician, a famous actor or a billionaire your priority in the health system seems assured. 

For the other 96% of humanity, healthcare is often a lottery.  Under supply and excessive demand mean the sick must wait in queues for treatment, the quality of which is sometimes limited by some institutions willingness to pay.  You might get an x-ray but you won’t get an MRI.  You won’t get titanium in your reconstruction it will be plastic.  You might get a general surgeon as opposed to an expert specialist.  Conversely, a member of the British royal family, the prime minister, a president, a senator is often pushed to the front of the line and treatment, unlimited by quotas is the best that current medical technology has to offer.

Collapse of the Health System

It doesn’t help of course that governments still condone smoking for the most part or refuse to recognise the link between increased incidence of obesity, diabetes or kidney disease with increases in high starch, low-fat food alternatives high in sugars.   In other words, dietary disease is so prevalent that public and private health schemes in Australia are predicted to collapse from overload, within ten to twenty years. 

The Vagaries of the Australian Health System.

The Australia health system is a complicated amalgam of public and private services that idiot bureaucrats mangled into the Medicare act in 1984.  Essentially today’s citizens and residents have the choice of using the “free” public health system by paying a little extra tax or taking private health insurance and paying premiums.  That doesn’t seem like an unreasonable choice except that the government in its wisdom continues to impose restrictions on just how much the private health insurer can pay towards treatment while the government picks up a large percentage of the cost anyway.

The end result of this voluntary “amalgamation” is that privately insured patients must pay an insurance premium (up to AU$300 a month or more), pay taxes to support the public system then pay the difference for treatment if a doctor or hospital should decide to charge more than the private and public health system is allowed to pay; an amount that can add up to many thousands of dollars.  In addition, the cost of doctor visits isn’t covered by private health insurance at all while the public health system only picks up about half to two thirds of the government’s suggested fee.  As well, important treatments (like chemotherapy) aren’t covered by private health insurance at all unless additional “incidental/accident” cover is taken to cover these costs up to some modest limit.  To add insult to injury the private health system doesn’t necessarily ensure faster or better treatment beyond a more comfortable hospital room than might be offered at a “public” facility. The end result of this charade is costly private health insurance but poor cover overall.

Orthopaedic Treatment.

My own experience with the Australian medical system goes like this:  On Good Friday I ruptured my distal bicep tendon.  I rushed myself to the nearest public hospital.  As one of only two patients in emergency I waited an hour for an intern to take a look at my injury and declare that the tendon “might be ruptured”.  No ultrasound, MRI or x-ray was suggested.  An appointment was made for me to attend the orthopaedic clinic ten days hence before I was sent home untreated, my arm in a paper sling worthy of something from a portable first aid kit.

Knowing that the injury needed surgery and that in medical terms a ruptured tendon deserves the same urgent attention as a compound fracture, I rang the orthopaedic clinic on the morning of the first working day after Easter, three days later, to plead my case.  Once staff realised my injury was urgent, that I had already been to emergency and was languishing at home untreated, an immediate ultrasound and doctor’s appointment was arranged.  It’s not clear if this sudden change in effort was spurred on by the realisation that emergency hospital staff had acted negligently or by pity.  In any case I was grateful for the expedited intervention.

When I finally saw the orthopaedic doctor she agreed surgery was required ASAP, to avoid further scarring or complications from delay.  The injured arm was then urgently immobilised in a proper “back-slab” cast until surgery could finally be administered.  I was subsequently sent home with assurances that surgery would be arranged for the end of that same week. 

A couple of days later the promised surgical procedure was booked for the coming Monday, or day ten after the injury.  However the Sunday night before the scheduled operation I received a phone call telling me the appointment had been cancelled because the hospital was full after a wave of weekend injuries took higher priority.  I would have expected to have been referred to another hospital but apparently that is not hospital policy; believe it or not the urgently sick and injured are just expected to wait even if they can be treated elsewhere sooner. 

In desperation I turned to the private health sector hoping to expedite treatment only to find that:  (A) There were few orthopaedic surgeons available within a 100km radius that specialised in distal bicep tendon reconstruction.  (B) Any doctors that could do the surgery were on vacation or simply didn’t have an available time-slot within the next two weeks.  (C) Doctors that were available and who had time flatly refuse to deal with self-funded patients.  It seems doctors are only happy to work directly with the sick as long as they have valid private health insurance.  Clearly such doctors aren’t taking their Hippocratic oaths seriously.

My only recourse was to repeatedly ring the public hospital that had now effectively refused to treat me twice, to politely nag the administration for a date when the promised surgical procedure might eventuate.  Finally, on Thursday, 13 days after incurring the injury while couch-bound and miserable, the hospital finally organised a slot for me in on Friday, the very next day.

By Saturday afternoon, the fifteenth day after my injury, I was discharged from hospital with my bicep tendon deservedly reattached.  Subsequent follow up treatment was prompt and reasonable so that by day 31 after the original injury I was able to swap the postoperative cast for an articulated elbow brace.  Finally I had enough function in my left arm to dress myself without help and use a computer keyboard to some degree. 

I could continue to find fault of course; the temporary elbow brace supplied by the hospital impinged painfully on the sutured 6 cm scar where the surgeon’s scalpel had cut my skin to access the fossa (inside hollow) of my elbow.  The prosthetic was the wrong size and didn’t support my forearm properly, hampering natural articulation.  Taking matters into my own hand I ordered a better fitting US designed brace online and use that, even today, to support my arm through the long recovery process. 

Regrettably, the whole experience has opened my eyes to the perils of the Australian healthcare system.  Armed with that experience, the best advice I can offer anyone is: “Stay healthy and don’t ever get sick”.  The less you need to rely on the health system the better off you will be.  That means eating well but without relying on the medical industry or the food authorities to tell you how.  Doing that also means being scientifically driven, open minded, becoming medically educated and doing a lot of research besides.

Hypocrisy

I am of course very grateful for the treatment.  I have nothing but praise for the hardest working people in hospital, the nursing staff.  And I commend the unsung caterers and cleaners, working in the background to pick up after everyone in the wards, washrooms and clinics.  I am indeed lucky to live in a country where medicine is available to everyone (eventually), where the hospitals aren’t full of people injured by war or afflicted by epidemic. 

Nevertheless, I am reminded of the inefficiency, arrogance, negligence and apathy that prevail within the administration of public (and private) healthcare systems.  I see hypocrisy where a hospital full of obese people and diabetics, the walking time-bombs of orthopaedic injury and dietary disease, serves sugary breakfasts of cereal, bread and fruit in between insulin injections.  I see machines in the halls vending out chocolate bars, potato crisps and junk foods to the same people between meals.  I see overcrowding because there are simply too few hospitals for the size of the population. 

Further Reading

Diabetes Epidemic, Sydney, Australia.