Welcome to the daily dose, with all the action and highlights from the 93rd RACS ASC in Sydney.
US-style privatised healthcare: a cautionary tale With workforce shortages, long elective surgery waitlists, clinician burnout and more, large-scale privatisation might seem like a tempting solution for Australia and Aotearoa New Zealand’s healthcare systems. Dr Will Flanary came all the way from the US to set us straight.
To a packed Darling Harbour Theatre, he was emphatic: “Let me just say, don’t do that.”
For the next 45 minutes, Dr Flanary, a US ophthalmologist and viral comedian known as Dr Glaucomflecken, took the audience through a sobering yet hilarious look under the hood of the US health system; what is broken, why and how Americans are fighting back.
After a wry warning – "this is going to be fun for you but incredibly depressing for me" – things indeed got dark as he talked of the conflicts of interest and corporate greed that cause administrative nightmares for clinicians and potential financial ruin to patients.
The array of costs insurers pass on to patients – from premiums and deductibles to co-insurances and co-payments – are just the beginning. There are also the delays caused by prior authorisations (34% of doctors report these have led to a “serious adverse event” for one of their patients) and claim denials, which insurers take an average of 1.2 seconds to decide on without having to explain why.
Vertical integration might be the most concerning trend of all, as insurers invest in hospitals and pharmacies, extending their market dominance and giving them more control over prices.
“We’ve given the power and decision-making to people who do not care about patients. They have no duty of care to patients. They have duty to shareholders.”
What’s all this got to do with Dr Glaucomflecken of social media fame? Along with many other Americans, Dr Flanary’s fighting back. He does this through education. With an audience of over four million and a growing international profile, Dr G is doing his best to get the toothpaste of privatised healthcare back into the tube. Plenary session: navigating innovation and integrity With 80% of jobs estimated to be impacted by AI, Professor Adam Bridgeman, Pro Vice-Chancellor (Educational Innovation) at The University of Sydney, delivered a stark warning in the plenary session on AI in Surgery: we must lead AI, not become slaves to it. He also discussed the growing challenge of detecting and preventing cheating in an age dominated by AI, sharing some James Bond-worthy examples of the lengths some students will go to, including "cheating glasses" and up-the-sleeve cameras. With three million assessments happening annually at the university, staying ahead of this powerful technology is no small task. The session also featured the ANZ Journal of Surgery Lecture, delivered by Professor Julian Smith, Editor of the journal and Head of Monash University’s Department of Surgery. Professor Smith reflected on the journal’s journey, from its first print issue in 1931 to its transition online in 2022. Next for the ANZ Journal of Surgery is the launch of an AI manuscript handling system which will tackle some of the biggest challenges to academic publishing, including finding appropriate and available reviewers and editors. This innovation promises to improve access and equity in authorship and knowledge distribution – particularly for non-native English speakers and those with language disabilities. However, Professor Smith stressed that human expertise is still essential for reviewing and editing, cautioning against preferencing speed over rigour. Question Time with Tony Jones In a wide-ranging panel discussion moderated by veteran Australian journalist Tony Jones, leaders in the health sector and surgical profession provided their commentary on the current state of health policy and funding in Australia. Two of the recurring themes that arose during the panel discussion were the role of private healthcare in the Australian health system and strengthening the rural health workforce. Dr Bridget Clancy called for a model of training where rural health professionals are trained for positions in rural areas, as opposed to uprooting practitioners from metropolitan areas. This approach is more likely to lead to long-term retention of health staff in rural areas. Dr Clancy celebrated the high calibre of rural health professionals, with rural medical students outpacing their metropolitan counterparts and rural healthcare being cheaper to provide than in the cities. Adventist Healthcare CEO Brett Goods emphasised the importance of private healthcare In Australia’s blended health system and shed light on the challenges that private hospitals are facing. With most private hospitals currently running at a loss and their demands for additional funding, it is a challenge for the government to keep private health insurance premium increases at sustainable levels. Associate Professor Catherine McDougall, Chief Medical Officer of Queensland Health, and Australian Medical Association President Dr Danielle McMullen, echoed the importance of having a balance of both strong public and private healthcare in the system. The Australian Government Private Health Insurance Rebate is an example of how the government supports private health care provision. Professor Frydenberg drew the audience’s attention to the importance of the work by RACS' Health Policy and Advocacy Committee, with the College now making up to 60 submissions annually to the government in Australia alone. He highlighted the importance of Fellows having a seat at the policymaking table and said medical colleges should be able to access government health workforce data. Professor Frydenberg also shared a number of strategies that could be deployed to enhance care and reduce surgical waiting lists in rural areas, including shared appointments and greater support for isolated surgery centres. As the NSW Parliamentary Secretary for Health, Dr Michael Holland MP responded to audience questions regarding ongoing concerns around pay and conditions for nurses and doctors in NSW Health. Dr Holland expressed the NSW Government’s position that it has agreed to negotiate, with an independent adjudicator to decide on pay issues. However, he also emphasised that the NSW Government does face financial constraints with a $187 billion debt burden and a 15% pay rise called for by nurses projected to cost $6.5 billion. With the resounding election victory of the Albanese Labor government on Saturday, there is now a strong mandate for the government’s commitments to the health sector and an expectation to continue its engagement with medical colleges and societies to address these important issues.
Thank you to Tony Jones and all the panellists for such a candid and vibrant discussion. |
