Australian health review : a publication of the Australian Hospital Association
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The implementation of National Health Service (NHS) reforms left the Conservative Government with a major electoral problem. As Britain approached the 1992 general election, opinion polls revealed a popular perception that the Conservatives were planning to privatise the NHS. This perception was both fuelled and acted upon by the Labour Opposition which, at its 1991 annual conference, signalled its intention to make the health service a major item on the electoral agenda. ⋯ The ways in which the Labour Party sought to place health on the electoral agenda are examined, together with the response of the government. Labour sought to portray the reforms as creeping privatisation while the Conservatives dismissed this as a crude propaganda ploy and have stressed their commitment to a more effective NHS. It is argued that the British experience exemplifies the perennial problems for any government seeking to introduce substantive changes to a national health system in a partisan political environment: the need to explain changes and legitimize them, and the danger that reforms will be politicized by an opposition eager for issues with immediate popular impact.
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Against a background of the appalling health problems experienced by indigenous Australians, the following discussion details the current status of health services for Aboriginal and Torres Strait Islander peoples and recent government and non-government initiatives to address these problems. In many localities, health services are overwhelmed by the tasks confronting them. State and Territory governments, having primary responsibility for the health of all citizens, must act in close cooperation with local communities, the Aboriginal and Torres Strait Islander Commission (ATSIC), regional councils and Aboriginal health services to ensure inequalities are addressed in health service provision to Australia's indigenous people. ⋯ A primary task remains to implement broader scale changes relevant to Aboriginal and Torres Strait Islander people within the mainstream health services. Mainstream services have the primary responsibility, and are funded on behalf of the whole population, to address health problems in a working partnership with the communities they serve. The Australian Hospital Association and its membership can help to improve the health of indigenous peoples by actively and sensitively working with them in the localities where they live, and through advocacy in the policies and plans that shape the whole of our health system.
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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.
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This analysis of the use of acute hospitals by older people identifies the extent of long stays by elderly patients and the eventual outcomes of these stays in terms of separations to residential care or the community. The effect of casemix on length of stay and differences associated with location of hospital are also discussed. ⋯ These patients use some 9% of all acute bed days and, in most cases, these beds would otherwise be unoccupied. It is unlikely therefore that they are 'blocking' beds that could be used to relieve waiting lists.
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Privatisation is once again back on the Australian political agenda. More significantly, privatisation has become an issue in the health care industry, following a proposal by the New South Wales government to privatise a public hospital in Port Macquarie. The main aims of this article are to discuss: the international move towards privatisation, the benefits of privatisation, the problems associated with privatisation in health care, and the potential health care services which could be privatised.