Doctors Reform Society of Australia
			supporting health care reforms to ensure justice, equity and quality care for all
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4.1  Australia's Health Care System
4.1.1  The DRS believes that the provision of comprehensive accessible and universal health care services should be the governing principle of all of Australia's health care services.  these services should be funded by one universal health insurance system, with monies generated solely through the taxation system.
4.1.2  The DRS believes to achieve this, the present Medicare system should be maintained and extended towards free, publicly operated community health and hospital services.  Health care funding should be used to encourage development of multi-disciplinary health clinics with participation by the community and health care workers as well as medical practitioners in the organisation and management of health care services.
4.1.3  The DRS calls for increased federal decision making and less duplication between State and Federal governments in health care.
4.1.4  The DRS believes that health outcomes of the health care system should be evaluated and providers should be accountable to the community, in terms of both cost and quality for the outcomes achieved.

4.2  Management Arrangements
4.2.1  The DRS supports a planned regionalisation of health service facilities including hospitals, with particular attention to be paid to democratic control via regional health councils, and the encouragement of close working relationships between health workers in hospitals and those in the community including private practitioners.
4.2.2  The DRS supports a uniform system of health services statistics in both the public and private sector, which should be accessible to the public.  Available resources should then be able to be matched to identified needs, leading to efficiency and equity of health care services.
4.2.3  The DRS opposes the establishment of for-profit health maintenance organisations.

4.3.  Primary Health Care and Community Health
4.3.1 The DRS acknowledges that the term 'primary health care' describes a sector of service delivery and a set of principles about how health care should be delivered.  These principles include:
    i. support of consumer and community involvement in health care decision making, at the clinical and policy levels;
    ii. developing models of practice which address the immediate and personal needs of individuals and communities but in ways which also help to redress the societal dynamics which reproduce those patterns of need;
 iii. developing shared understanding and collaboration between different practitioners and agencies in the primary health care sector serving the same communities (general practitioners, community health nurses, pharmacists, local government and other health practitioners);
    iv. developing mutually respectful collaboration between primary health care practitioners and more centrally located experts and specialists.
The DRS believes:
4.3.2  Primary health care services should be available to all including the rural and isolated, newly arrived and refugees as well as the general urban based populations.
4.3.3  Primary health care services should address individual, family and community needs; should provide sick care and contribute to health promotion; and should involve practitioners from a range of disciplines and backgrounds.
4.3.4  On-going and active involvement of consumers and service providers is essential in the planning, implementation and evaluation of primary health care policies and services.  Governments at all levels and institutional health care providers should support consumer participation in health decision making.
4.3.5  Primary care doctors and their professional organisations should be encouraged to see themselves not as isolated practitioners, but as part of a broader primary health care setting.
4.3.6  All staff should have training and education appropriate to their roles.  Vocational training for primary care physicians should be available to all doctors entering primary care. Continuing education should be available to all health care workers on a decentralised basis. (see also Medical Education 5.1.1 iii and Medical Workforce 5.3.3)
4.3.7  Primary Health Care Outcomes:
The DRS believes that, where practicable the outcomes of primary health care services should be evaluated, whilst recognising there are limitations in evaluating primary health care services.  The evaluation of the process of care should be based on the best available research evidence demonstrating the links between particular strategies of practice and good outcomes.

4.4  Hospital Services
4.4.1  The DRS believes that expensive facilities and equipment should be provided on a carefully planned basis to populations large enough to justify their use.  Such facilities should not be open to exploitation by privately controlled interests, and should preferably be located in public hospitals.  Appropriate quality assurance assessments should be mandatory for all hospitals.

4.5  Long-Term Residential Care
4.5.1  The DRS supports the phasing out of large specialised institutions for people with mental illness, intellectual and physical disabilities and their replacement by small units in general hospitals and integrated community based services.
4.5.2  The DRS supports the integration of persons with physical or intellectual disabilities into the community and an inclusive approach to the provision of school and employment, together with specialist services and community assistance to meet specialised needs.
4.5.3  The DRS believes funding should be available so individualised support can be provided to meet the needs of those people to support their integration within the community.
4.5.4  The DRS supports the principle that people with disabilities should enjoy the same rights as all Australian citizens including the right to the same standard of medical services.

4.6  Private Medicine
4.6.1  The DRS believes funding for the private system should not be at the expense of the universal health care system.
4.6.2  The DRS is vehemently opposed to moves by State and Federal Governments to privatise public health facilities.  The DRS believes that privatisation of public health facilities results in the provision of poorer quality, less accessible services to the Australian community at a higher cost than public facilities.
4.6.3  The DRS calls on the Federal Government to enforce the State-Federal Medicare agreements and prevent further cost shifting and erosion of the public hospital system.

4.7  Specialists
4.7.1  The DRS believes that:
    i. specialist practice in public hospitals needs to be increased;
    ii. such practice should be mainly as fully salaried positions;
    iii. where part time positions exist they should not be fee-for-service;
    iv. the right to private practice in public hospitals should be restricted to those health areas where no appropriate private facility exists.
(see also Medical Workforce 5.3.2)
4.7.2  The DRS, in supporting an increase in numbers of specialists, believes that:
    i. specialist colleges need to increase the training positions in those specialties in which   there are shortages or projected shortages;
    ii. all non accredited registrar positions in teaching hospitals with approved specialist training positions should be upgraded to approved training positions;
    iii. the specialist colleges need to increase the transparency of their selection criteria for entry into training;
    iv. the training of general practitioners in selected work currently performed by specialists should be encouraged, especially in areas of under supply of specialist services.
(see also Medical Workforce 5.3.3 and 5.3.4)

4.8  Role of Non-Medical Health Professionals
4.8.1  The DRS supports the role of nurses and allied health practitioners in the delivery of health care, and seeks to increase cooperation between medical and non-medical health practitioners.
4.8.2  The DRS believes that suitably trained non-medical health professionals such as nurse practitioners have an important primary care role.
4.8.3  The DRS believes that independent midwives provide a useful community health service and that this requires further investigation and support.
(see also Primary Health Care and Community Health 4.3.1 iii & 4.3.3 and Women's Reproductive Health 8.2.3)

4.9  Evidence-based Medicine
4.9.1  The DRS supports the appropriate use of evidence based medicine as a useful tool in promoting quality patient care and health service planning and delivery in many circumstances.
4.9.2  The DRS supports the Federal Department of Health funding an Australian evidence-based medicine centre.
4.9.3  The DRS believes licensing of new pharmaceuticals and other treatments should only occur when sufficient evidence is available to demonstrate their benefit over current treatments.  Other agents should only be licensed for use in properly conducted clinical trials.
4.9.4  The DRS believes new surgical procedures should be subjected to a similar degree of scrutiny as that to which new pharmaceuticals are subjected.

4.10  Euthanasia
The DRS believes:
4.10.1  Active euthanasia (giving treatment to hasten death) should be regulated by legislation.
4.10.2  Active euthanasia should only be available if safeguards are met, and these should include:
    i. A well-informed, free, enduring and documented request by a person when of sound mind which leaves no reasonable doubt concerning their desire to die under the present circumstances.
    ii. Adequate assessment and trial of treatment possibilities.
    iii. No realistic chance of significant clinical improvement.
    iv. The opinion of more than one medical practitioner.
4.10.3  Resource allocation issues should not influence decisions regarding active euthanasia.
4.10.4  Individual medical practitioners should be free to refuse to assist in active euthanasia, but should not impede patients from consulting other practitioners who may be willing to assist them.
4.10.5  Persons of sound mind should be able to request that life-prolonging treatment be withheld or withdrawn.
4.10.6  Persons not of sound mind should have life-prolonging treatment withheld or withdrawn only if safeguards are met, and these should include:
    i. Consideration of requests made by the person while of sound mind, and the opinions of their intimates, regarding treatment under the present circumstances.
    ii. Adequate assessment of treatment possibilities.
    iii. No realistic chance of significant clinical improvement.
    iv.  The opinion of more than one medical practitioner whenever practical.
4.10.7  The DRS believes it is the right of all individuals to receive optimum palliative care when needed irrespective of financial means or geographical location.  Immediate attempts must be made to provide this for all Australians.  Legislation regarding euthanasia should not affect this right, and especially should not detract from adequate funding for palliative care.
 

.		.	The Doctors Reform Society of Australia, Box 14, 4 Goulburn Street, Sydney 2000. Phone 02 9264-9084 Fax 02 9267-4393.	.
			This page was last updated on 29th January, 2003.
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