Friday, November 15, 2013

If This Is The Quality Of Medicare Local Leadership We Have There Is A Big Problem.

This popped up today.

No free universal health for unhealthy choices: McRuvie

15th Nov 2013
A MEDICARE Local CEO has surprised colleagues by saying she does not believe in universal free healthcare, and by suggesting people should be punished financially for their unhealthy lifestyle choices.
“Universal free healthcare I don’t think is a good thing,” Central Queensland ML CEO Jean McRuvie told the Australian Medicare Local Alliance’s National Primary Health Care Convention on the Gold Coast last week.
The remark, in a panel discussion, elicited murmurs from an audience of more than 1000 delegates. Asked to elaborate, Ms McRuvie, whose ML area has one of the highest obesity rates according to the National Health Performance Authority (NHPA), said she questioned giving free healthcare to people who made poor choices.
“We all say ‘the cost of health care is high’. Why are we not paying for our healthcare?” she said.
“Why are we not rewarding people by giving free healthcare for doing all the things they should do to maintain their health?”
“You teach children ‘if you do that, there is a consequence’. We need to have some hard conversations about healthcare.”
She added that many good GPs were ordering unnecessary tests “just because it’s free”.
More here:
This CEO is clearly severely out of step with anyone who knows anything about health service delivery and what nonsense this is. She simply needs to just resign. She clearly has no place managing health services delivery.  Minister Dutton needs to make sure ML leadership have a clue and are not in the game of punishing people.
Nutty Right Wing Queenslanders strike again!


Anonymous said...

She might not be politically correct but there may well be a grain of truth in what she says. Some sort of co-payment system might actually make people think about the fact that poor choices and poor health cost $$$. Its not about denying people healthcare, but introducing a personal responsibility signal into their lives.

Tom Bowden said...

David, For the first time ever I find myself completely disagreeing with you. People should be penalised for making poor lifestyle choices and rewarded for making good ones.

It is the only way we will properly manage healthcare delivery in the future.

I think she should be promoted.

Kind regards,
Tom Bowden

Terry Hannan said...

Maybe Ms Jean McRuvie can gain some "insight" / "learning" from this. Her understanding of health care costs would appear significantly deficient.
Hannan TJ, Celia C. Are doctors the structural weakness in the e-health building? Internal medicine journal. 2013;43(10):1155-64. Epub 2013/10/19.

Enrico Coiera said...

One major problem with the reward/punish model of health behaviour change is that it assumes everyone is on an even playing field, with the same options and capabilities and that some are being 'bad' despite what they are told.

Yet when you look at problems like obesity, alcoholism etc what do you see? - a strong correlation with lower socio-economic status, and educational opportunity.
Apart from not necessarily hearing the messages we send them, nor having role models to shape their behaviour, they may not even have the food choices we'd like them to make available - think rows and rows of chip packets and soft drinks when you walk into Coles and Woolies

So beating up on people who are not equipped to make good choices is not a great idea.

That's why there is merit in a broader strategy - 1/ education, 2/ ensuring there are real healthy options available, and yes, 3/ slight nudges to direct in one behavioural direction over another - like the tax on soft drinks in new york.

I personally suggest that Coles and Woolies must be legislated to truthfully brand their products. Instead of the soft drinks aisle for example, the should label the aisle "Diabetes'. Instead of chips, biscuits and snacks they should label that aisle "heart disease, hypertension and obesity".

Anonymous said...

This contentious argument illustrates precisely why Healthcare is such a "Wicked Problem"!

Ms Jean McRuvie has a legitimate point to make in that the concept of "Moral Hazard" is not only applicable to financial markets as an economic term. Socioeconomic disadvantages not completely put aside, a genetically predisposed healthy person making poor health choices through poor diet and/or smoking and/or alcohol abuse and/or no exercise, where their inevitable costly healthcare bill is picked up by the socialised healthcare system is not exercising personal responsibility and letting others (taxpayers) pick-up the tab for their own health irresponsibility. In this instance, there is an unequivocal injustice within the system when other responsible healthy individuals, especially in the same socioeconomic bracket are paying higher taxes and healthcare costs for others health recklessness. I believe this was the point Ms McRuvie was attempting to make in her referred to statements and I don’t deem them right-wing craziness.

The socioeconomic issues raised by Enrico contributing to these adverse and perverse health system outcomes run into much deeper issues around the distribution of wealth and opportunity within our society as a whole, and go way beyond the impacts to health and the type of healthcare system, and are very much entangled within a hornet’s nest of wicked problems with no easy self-evident solution on offer to resolve the malaise!

Previously recommended reading on this site confronting this contentious and thorny issue head-on:

"Terminal Decline" (Khadra, 2011)

We need much louder and far greater voices than Ms McRuvie engaged on all sides of this debate if Australia is going to lift its weary healthcare head out of its delusional sand and conduct the required healthcare reform it increasingly needs to address the present and ever growing challenges and demands of its healthcare system capability and resource requirements.

Dr David More MB PhD FACHI said...

My view.

Those who want to not provide healthcare support because of bad lifestyle choices need to just grow up.

Life choices and outcomes are the result of a vast mix of social, economic and other factors. Some we can control, some we simply can't (think child abuse, violence, poverty etc.).

Some prosper, some don't but we need to look after everyone's basic needs. If this offends you just go elsewhere.

If we are not the sort of society that cares I want out!


K said...

Actually, poor lifestyle choices don't necessarily increase the total size of the bill. In fact, going out quickly with a heart attack is cheap. Growing old is the really expensive thing to do.

Healthcare... full of perverse incentives

Marcus said...

I remember a story of a bus driver that drove past all the bus stops on his bus route and didn't bother picking any of the passengers up. When the inspector finally caught up with him, the bus driver told the inspector "I don't have time to stop for passengers if I am going to meet your timetable".

This comment is a hierarchy looking to scale back on its purpose to the community.
The healthcare system is so busy with process that it doesn't have the resources to treat patients under a universal health care system?

New technologies should be applied to free people and resources from organising process in "Information Age" health. Those resources and people can be redeployed to the front line.

Anonymous said...

The AMLA conference provided much thought provoking conversation but key messages were clear:
Health reform is not about systems its about health. We need better outcomes and we need to redesign the process to provide these - making people pay for bad choices is not the answer.

Deb said...

Mike Farrar from the NHS Confederation in UK (at the AMLA conference) told us that health is personal, emotional and irrational and that we need to find ways to empower the people to take responsibility and access services. Irrational responses to this - bad choice you pay reaction, will not work. We are focused on keeping people well and out of hospital - not penalising them for unwise lifestyles and choices - do we consider that our sportsmen and women should pay for the inevitable knee reconstruction?

Anonymous said...

A system set-up to reward good behaviour and choices and penalise bad behaviour and choices is not an "irrational" system.

If you think it is irrational, then I would like to hear more about your views on the "Legal and Justice" system!

RE: "do we consider that our sportsmen and women should pay for the inevitable knee reconstruction?"

Seriously? If not them, or those who choose to insure them, then exactly who should be paying for the inevitable knee reconstruction?

That's right, let's penalise the average punter trying to lead a good healthy life, make good healthy choices and pay for other sporting peoples injuries that have nothing to do with them whatsoever and have not benefitted them at all.

What appears to be representative of rational and irrational in this discussion seems to be a very blurry proposition to put it lightly.

It's interesting how all thoughts and compassion may be laid on those making poor lifestyle choices detrimental to their own health (not speaking about the genetically tragically unhealthy and disabled or those disabled and injured through no fault of their own) with innocent citizens left paying their hefty healthcare costs, and yet no compassion is expressed or spared for those innocents doing the right thing making good healthcare choices and being forced to sacrifice their own and their dependents, yes even in the very lowest of socioeconomic classes, better health and welfare from resources unjustly appropriated through the tax system to pay for others elevated healthcare costs.

Why are these citizens worth any less care and compassion when they are left paying the avoidable Bill for others poor lifestyle choices?

Responses in terms of “Moral Justice” would be welcomed as in a Socialised Healthcare System, this point of discussion is indeed a case of “Moral Hazard”!