Tuesday, March 4, 2008

GP Waiting Lists

The Australian Federal Government has announced it plans to publish details of waiting lists. This is one piece of information consumers would like to see. The single biggest complaint about the health system is how long it takes a patient to recieve treatment. It is preferable to provide information on waiting times than on the numbers of people waiting for treatment.

I wonder how this information will be presented? Will it be presented in a manner that makes it useful for consumers? How will the hospital sector use this information? Will it reduce the actual waiting lists? Will health funding be tied into reducing waiting lists? Why should a hospital be funded to provide a service and then retain that funding when it fails to deliver? Will the waiting list information distinguish between in-patients and out-patients?

Logically the information should be broken down by State and then by hospital. There are difficulties in doing this however. Not all hospitals provide all services and in breaking down to the individual hospital inequities and anomolies might be created. It would be helpful to have the waiting list broken down by surgical procedure. The issue with aggregating State information is that it becomes difficult to hold individual hospital administrations to account.

Perhaps the Federal Government should also look at publishing details of the waiting list for those with private health insurance and seeking care in the public system and those without private health insurance. In this way it might be possible to identify the level of queue jumping that is percieved to take place. Likewise information on the number of surgical procedures that were 'rescheduled' and the reason for that would help also to induce a sense of accountability within hospitals. If rescheduled surgery information was provided, would the waiting times be accumulated for each patient or would only the shortest, most recent period of time be recorded?

Ten years ago, in 1997, in NSW, it was reported that there were often two waiting lists. One held by GP's and one maintained by surgeons. Perhaps the Government could collect data showing the differences between the information provided to GP's and what actually takes place.

Reducing waiting lists is important to consumers. There are records of people actually dying or suffering greater illness while waiting to recieve treatment. At the same time consumers have few options as to which hospital they might go to and recieve treatment. Yet that is not sufficient reason not to collect and publish data. Consumers pay for hospitals, they have a right to information on performance. Hospital adminstrators have an obligation to spend public money in an effective manner.

What might the Federal Government do with this information? There is little evidence to suggest that spending increased amounts on infrastructure and or additional specialists will actually reduce waiting lists. There is a straightforward reason for this. Specialists will act to protect their own interests. The answer may lie in removing the final decision from the specialists. Hospital waiting lists are also a necessary evil. Considerable investment is made in infrastructure, staffing and equipment. These resources cannot be allowed to remain idle. The aim should not be to eliminate waiting lists, rather to minimise the time an outpatient spends waiting for treatment. While decisions will always need to be made on a individual case basis, there is evidence that minimum waiting times can be introduced and maintained.

The case for minimising waiting lists is not a one way street. Consumers also have to take responsibility for their behaviour. When a patient doesnt turn up, as scheduled, for an appointment or procedure, they have effectively wasted an opportunity, not only for themselves, but they may also have contributed to someone else's misfortune. If hospital administrators are to be penalised for poor performance then it is reasonable to suggest consumers should also be penalised for poor performance.

GP's themselves may have to take greater accountability for their actions. GP's cannot treat every health issue, therefore they refer patients to specialists. How may times is this done for convenience sake? The Federal Government has clearly set out its priority and focus upon primary health care. Is it possible GP's might collaborate more with the primary care sector and perhaps consider referring patients in this direction, for preventative action, rather than automatically referring to a specialist? This might have a double benefit in that it may contribute to reduced waiting lists while also helping patients take greater responsibility for their own health outcomes.

Maybe it is time for greater collaboration between hospitals within States and between various State health sectors. Collaboration may lead to improved utilisation of resources within hospitals. Not every hospital in the country is fully utilised at the same time. While this would mean some consumers having to recieve treatment away from their home region - at least consider giving them the option. For some consumers the option of treatment now in another state would be preferable to waiting on a list for an unknown period of time.

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