Issue 15 / 27 April 2015

IN the lead up to the launch of Choosing Wisely Australia this week, its newly appointed chair, Associate Professor Richard King, spoke to MJA Engagement and News Editor Cate Swannell about the aims of the campaign.

In a wide-ranging conversation about low value tests, treatments and procedures that learned medical colleges and societies are identifying to be included in the campaign, Professor King was careful to emphasise that the initiative was not primarily aimed at reducing health spending:

“If there are cost savings we’re all very keen, but cost saving isn’t what this is about… The aim is for patients to get the best from their doctors and for doctors to be as well informed as they can be.”

Regardless of Choosing Wisely’s intent, the cost savings aspect of the program has certainly caught the attention of federal Health Minister Sussan Ley, who last week announced several new initiatives to trim down the “sluggish, bloated” Medicare system, including a review of the evidence for the more than 5500 Medicare-funded services to weed out those being used inappropriately.

At times like this, there is a good chance that the government’s agenda to save money and the quality goals of health policy experts are in sync. At other times, such as with the current standoff between the Commonwealth and the states regarding public hospital funding, they are not.

Writing for MJA InSight in the wake of the release of the AMA Public Hospital Report Card, emergency physician and AMA vice-president Dr Stephen Parnis warns that if funding cuts to hospitals are followed through “something has got to give” — and it will be patient care.

Health and health care are examples of the fact that not everything can be commodified. What price, for instance, the loss of a healthy kidney?

The issue of paying live donors has surfaced again in one of our news stories this week, after a qualitative study conducted in Australia found some traction among the public for the concept of reimbursing living kidney donors for their costs and providing reasonable compensation, but less enthusiasm for incentive payments over and above this.

Mark Ragg reminds us in his InSight column this week that a crisis looms for about 12 000 people who currently reside in the remote communities in Western Australia that stand to lose essential services if government funding is withdrawn.

The details of what is planned have become confused, but much of the discourse has involved price and cost — the WA government citing the high price of providing services, while others pointing out the costs of dislocating the people currently residing in the doomed communities.

These equations will continue to be debated, but how much better would it be if we placed a value on intangibles like connectedness to country, culture, community, autonomy, history, story and respect.

If we could all see the value of intangibles, and not just the bottom line, who knows, we might just come up with a way forward that meets everyone’s needs.


Dr Ruth Armstrong is the medical editor of MJA InSight. Find her on Twitter: @DrRuthInSight

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