Australian health review : a publication of the Australian Hospital Association
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Australian political leaders and policy analysts have increasingly sought to learn from Singapore, a nation which, despite its small size and lack of natural resources, has enjoyed rapid economic growth. Of particular interest to Australian policymakers has been Singapore's compulsory superannuation system, which has provided high levels of domestic savings and high levels of home ownership; it has also incorporated a scheme to enable Singaporeans to save for the costs of health care. ⋯ Saving for health care costs has been a largely neglected option in recent policy debate about reforming funding arrangements for hospital care in Australia. The potential for a formalised scheme for medical savings in Australia, subsidised by taxation concessions, is explored in terms of its socioeconomic policy implications, its congruence with Australian values, and the logistical ramifications of such a scheme.
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Laparoscopic surgery continues to evolve and to offer major potential for achieving benefits to patients and to health care providers because of decreased morbidity. Laparoscopic cholecystectomy has diffused rapidly and widely. However, the spread of other minimal access surgery methods has been more gradual, reflecting uncertainties as to the degree of benefit and rate of change of technology. Firm evidence of efficacy and costs of the new methods is still limited, and a number of organisational issues continue to demand attention.
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Although constrained by Federal financial dominance, State governments can, nevertheless, significantly shape a number of aspects of health policy within their own jurisdiction. New governments often seek to implement both substantive and symbolic policy changes. This is often also accompanied by alterations to organisational structures and personnel with a view to making implementation more effective. ⋯ The decision-making style of the new government is also discussed. The authors regard the economic imperatives of Victoria's severe deficit as the dominant influence in all areas of public policy, including health services policy, although certain ideological predilections have also been evident. They further argue that the new government has primarily sought legitimacy by appealing to what it regards as its mandate to rectify Victoria's 'economic crisis' by reducing public expenditure and reforming managerial practices in the public sector.
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Comparative Study
The effects on hospital use and costs of a domiciliary palliative care nursing service.
An economic evaluation of a domiciliary palliative care nursing service operating in NSW assessed the extent to which the program provided more cost-effective care at home, prevented admissions to hospitals and shortened lengths of stay for patients in the terminal stages of cancer. Hospital use (inpatient days) and cost during the patients' last 90 days of life were compared before and after the introduction of the program. There was no statistically significant difference in either and hence no savings to offset the operating costs of the program. However, future savings might be achieved if after-hours access to painkilling drugs is improved.