HEALTH CARE: by Jeffry Babb News Weekly
Australian medicine's middle way
, November 22, 2008
The Australian health system is neither fully socialised nor fully fee-for-service, writes Jeffry Babb.Who is Australia's highest paid doctor? If you guessed Dr Edmund Bateman, you were right. Dr Bateman runs Primary Healthcare, a major ASX-listed company. As managing director and major shareholder, he's a regular on any rich list.
Dr Bateman is a general practitioner, but Australia's other 22,000 GPs don't take home the estimated $50 million he earned last year. Talk to any general practitioner and you will hear that it's a job with a lot of responsibility and relatively low pay. There is no shortage of jobs going around. Take a look at a job site and you'll find dozens of openings for GPs all over Australia.
General practice is now a specialisation like any other medical specialisation, requiring specific training and qualifications. Earnings, to a large extent, are dependent on what the government pays for a consultation under Medicare and how long you are prepared to work.
According to government estimates, the average GP works in excess of 50 hours a week. Earnings depend on the nature of the practice and the level of the GP's involvement.Buying into a practice
Many GPs work on contract for a flat fee and then have to take out a loan - frequently rolled over from one year to the next - to pay their tax. The alternative to working for a flat fee is to buy into a practice. This commonly costs a million dollars.
The average GP would earn in the region of $100,000 per year, depending on his (or, as is now common, her) level of involvement. Of course, practice-owners and others in lucrative practices would earn more.
Still, considering that medicine is regularly among the hardest professions to enter based on tertiary entry scores, and considering that it often takes 10 years or more before medical practitioners earn a reasonable return on time invested in study and money spent on fees, it's not a massive income.
That Australia has a shortage of doctors, especially in rural and remote areas, is not news. But overseas doctors, who are lured to Australia with the promise of a better climate and better earnings, are often restricted as to where they can practise. Commonly, they are forced to work in remote areas, or in after-hours practices. Therefore, Australia may not be such an attractive proposition as we - or they - imagine.
Doctors working in rural areas are often expected to be medical supermen. They frequently run a hospital, perform surgery, act as a district-wide emergency service and act as anaesthetists, as well as deliver babies. Rural and remote medicine can be challenging and demanding, but it is immensely rewarding as well.
Medical care is affordable for Australians, but can often come at a price if you want more immediate attention.
Take Canada, for example. The great bogyman in Canadian politics is "two-tier medicine". Although cracks are beginning to appear, it has been actually illegal for a patient to pay for quicker service. The alternative is to go to the United States, where care is quicker - and a lot more expensive. When Americans talk about the horrors of socialised medicine, it's often Canada they have in mind.
The United States has the best medical care in the world - if you can afford it. But it also has elements of socialised medicine, a fact which is commonly misunderstood. It's a great challenge for some future president, but, in the current economic environment, President-elect Barak Obama may have little opportunity to do much about it.
The notion that medical care should be equally available to everyone simply flies in the face of experience. Medicine is a service industry and supply will never be available to meet total demand.
Inevitably, some new invention or drug will come along that increases the scope of medical care - often at considerable cost. As community expectations increase, so will the standard of care and accommodation to which patients will believe they are entitled.
Most Australians can assure themselves of a better standard of care and prompt treatment for elective surgery by taking out health insurance. For many families, private insurance is a financial stretch, but it can also be seen as affordable if other luxuries are forgone.
For an insight into what medical care was like for the Australian poor in the early days of the 20th century, Pickle to Pie
by Glenice Whitting (Melbourne: Ilura Press, 2006) is informative.Unaffordable
This book is about life in the western Melbourne working-class suburb of Footscray. A central character is a German midwife and herbal healer who assists girls too poor to afford hospital care for their babies. Medical care was simply out of reach for many working-class Australians in those days.
Whatever the faults of the Australian health system, we can be grateful that medical care is both affordable and available for the vast majority of people, and is neither fully socialised nor fully fee-for-service.- Jeffry Babb