Two tiers for health care

There was a fairly impassioned article in the SMH today about how the Australian health care system has very definitely become a two-tier health care system.

“the wealthy and privately insured get timely health care and the rest, unless they are critically ill, can wait.”

Except, as I blogged recently, if you are a child, in which case you mostly get superb care in the public health system, without regard to your income levels. An anecdote to support that. When Chatterboy was being checked in, we were asked whether we wanted to go public or private. There was no difference in care, we were told. But if he had been over 18, it would have been the difference between seeing the specialist, and seeing the resident.

Recent research commissioned by the NSW cancer council describes some of the human cost of the two tier system. For patients being treated for cancer, according to the SMH (this wasn’t in the summary article on the website):

“The report also revealed a gulf between different cancers in how much they cost the health system and individuals. People with prostate cancer bore 32 per cent and those with breast cancer 20 per cent of treatment costs, well above the 15 per cent average. The report said this was because “treatment of these cancers uses more GP and specialist services, and more pharmaceuticals, and thus individuals contribute more in the form of gap and co-payments”.

If you can’t afford to pay 15% of the cost of treatment, then it seems likely your treatment is going to suffer. You’ll probably have to wait longer for treatment. Your doctor will be less qualified. And to get the bulk-billed treatment you can afford, you will have to shop around to find a doctor to treat you cheaply. That doctor is probably not the most convenient, so while you are very sick, you’ll have to drag yourself out to an inconvenient doctor you can afford.

As the private health system has been propped up with legislative change (lifetime community rating) and tax incentives and rebates (it is cheaper for our family to have health insurance than not, even if we never claim a cent on it, because of the way the tax system works), the public system becomes the safety net, rather than a sytem that you can be happy to end up in.

In the end, health care must be rationed somehow. As society, we don’t have unlimited money to spend. And our rationing is a combination of using money, or using triage decisions by doctors within the amount of money available to the public system. But the relationship between those streams seems to have  changed.

For children, income plays a small part in determining what standard of care you receive. For adults, it’s playing an increasing part. I wonder whether this is because as a society our attitude to poor adults increasingly is that their poverty is self-inflicted.

At least children aren’t blamed for being born into a poor family (at least not in the health care system). But the implication of our increasingly two-tier health care system is that adults are less deserving of adequate health care if they are poor. And that is a sad reflection on society today.