Australian health review : a publication of the Australian Hospital Association
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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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Aboriginal people suffer from the worst health of any identifiable group in Australia due to profound disadvantages experienced by them since European colonisation of Australia. The Aboriginal community of south-west Sydney represents almost 25 per cent of Sydney's Aboriginal population. ⋯ The Working Group on Aboriginal Health has produced a Strategic Plan for Aboriginal Health in South Western Sydney. This cooperation has come from the development of trust, the identification of local needs and the elaboration of local solutions.
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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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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.