The future of health:

Dr John James writes: Re. "Two health insider views from the 2020 Summit" (yesterday, item 13). A colleague of mine and good friend, an oncologist here in Sydney, recently resigned from his teaching hospital position after nearly 20 years. He was a dedicated doctor, willing to treat and give his time where it was needed. He was not driven by a desire for a dollar. He has gone overseas and is practicing in Dublin. He chronicled to me one day, over a cup of coffee, the difficulties with cost cutting, but what really pushed him out was when he indicated to the area health service administrators that because of cost cutting and shortage of secretarial staff he was having difficulties replying to the referring doctors promptly. As he put it, some of his patients were dying before the referring doctors were aware of their progress. He indicated that, out of courtesy, he should write a simple letter of explanation to the referring doctors explaining why he wasn't replying more promptly. The area health service told him that if he did so he would be in breach of contract. They then broke into his personal hard drive and stripped it of sensitive information that the administrators were clearly anxious might become public information. Hospitals must be returned to local board administration made up of medical and nursing staff as well as local community representatives. They should be allowed to keep any money generated or saved and they must be run as business entities. They should be allowed to charge a fee for all services as they see fit and compete with other hospitals. Medicare assistance for hospital costs should be given directly to families and individuals, means tested, and money not used in one financial year could be "saved" by that family for future use. Hospital administrators and middle management should largely go. As my colleagues experience indicates they are completely out of touch. Finally, family medicine must be better funded. The system needs more well trained generalists to keep the chronically ill and the young out of hospital.