----- Original Message -----
Sent: Tuesday, April 30, 2002 9:31
PM
Subject: Fw: Health system chaos
----- Original Message -----
Sent: Tuesday, April 30, 2002 12:49 PM
Subject: Health system chaos
Dear Editor,
Re: Front page news, 30/4/2002 regarding medical
insurance.
The poor cousins of obstetricians, midwives,
recently lost their professional indemnity insurance. It did not become front
page news.
In July 2001, I wrote to the AMA, the RANZCOG,
and the Health Ministers Council meeting on professional indemnity
insurance. Those letters outlined the results of some obstetric
practices as being directly related to the following:-
high cost of maternity care
high cost of premiums
withdrawal of obstetric services in some
areas
withdrawal of GP obstetric services
the demise of independent midwifery
practice
loss of practitioners to maternity services
personal and professional suffering
physical and emotional suffering
to some parturient women
I wrote requesting co-operation from the AMA and
the RANZCOG, not only because of the threat to midwives and to the women they
served, but about the threat to obstetricians too, and about the deepening
crisis in professional indemnity insurance.
Also, that specialists should do what they were
trained to do - care for the 20% of women at high risk, leaving the 80% of
women with normal pregnancy and birth to be cared for by the most suitable
professional - the midwife.
The World Health Organization, 1985, recommended
that midwives be the professional primary carers of women during normal
pregnancy and birth, and following birth. The advice of the
WHO is often sought by countries on how to contain the costs of high
technological health care systems, yet is ignored because of the medical
hegemony.
The senate report, "Rocking the Cradle", 1999,
(to which the government objected as "time-wasting") recommended, amongst many
other things, the inquiry into medical indemnity and litigation, including the
impact of litigation and indemnity on the provision and practice of obstetric
services.
A recent article in the British Medical Journal,
15/4/2002, "Has the Medicalisation of Childbirth gone too far?", suggests that
(in the U.K.) 70% of litigation relates to
obstetrics. http://bmj.com/cgi/content/full/324/7342/0/e
At a wild guess, I'd say that the figure is
similar for Australia.
Private hospitals are costly, subsidized by
government and at whose cost??
The rates of obstetric interventions are highest
for private patients in private hospitals. (see www.bmj.com Roberts et al,
15/7/2000, 321: 137 141) Obstetricians in private practice
pay high insurance premiums; the public hospital system
usually
covers its employees.
Holland and New Zealand have the midwifery model
of obstetric care which -
is totally supported by national
government
has Treasury Managed Funds providing insurance to
all maternity care providers
is non-competitive amonst providers of maternity
care
has implemented a social system which provides
fully for disability in an advers event
has a review board which acknowledges mistakes or
mismanagemnet, to satisfy the claimant, and deals fairly and suitably with the
professional concerned
gives more choice to women, with over 30%
homebirth rate, and full social and professional support provided for a week
at government expense
A social model of childbearing is indispensable
to health promotion and public health, yet community and public
health
receives about 5% compared to hospitals
which take about 50% of the health spending budget.
If the health system is in chaos, one hopes it
continues until its demise, because only through destruction can creation of a
better, more sustainable, more equitable and just system occur.
Fair go, Australia - and for all.
yours sincerely,
Elizabeth McAlpine
Midwife
7/208 Edward ST.,
Brunswick East,
Melbourne 3057
93810649 0408146947
