Since starting work here in Perth it's been hard finding time to write blog posts, mainly because I don't have time to do things to write blog posts about. Also, we seem to be running out of things to do. Perth is a fair bit isolated from the rest of Australia, and we won't be heading out east to see the other sights of the continent until July/August.
In the meantime I've been trying my best to learn how the Australian health care system works here. It's a bit more complicated than I had thought it would be. Before I got here, I thought the most difficult thing to adjust to was the range of exotic animal related injuries I would have to deal with. So far, I haven't seen any box jelly stings, shark bites or koala amputations. Instead, I've been trying to get my head around the way I get paid.
Back home, if you need something medical you can swipe your card, receive your service (albeit slow), and walk out the door. Here, if you're not impoverished or over 65 you're expected to pay extra when you see the GP, somewhere in the order of $60-$65. It feels so strange to tell people "Pay me", and watch them crack open their wallet and hand me a stack of bills. If I tried to do that in Toronto, I'm pretty sure I would be drawn and quartered, College style (College style means Lawyer style. Lawyer style means painfully and slowly).
It takes a fair bit of time to get used to this new system, especially since sometimes you have to decide if you want to charge someone the full $60 for their visit or just bill the government instead, which will net you only around $30. For things like returning to the clinic for results, billing the government makes sense. But other times it's hard to decide, like someone getting diagnosed with cancer. It might make you feel like a heel to charge someone the full rate to find out they have a serious disease, but if you spend an extra half hour with them which puts the rest of your day behind and makes you miss your bus that makes you miss your train that gets you home an hour late, do you think it's worth getting the full price of the visit? Or if somebody just needs to renew their birth control prescription. Here's a responsible adult ensuring they don't need to have repeated abortions which are time consuming, resource intensive and largely avoidable. Should they be penalized for acting like mature members of society?
We met an Aussie GP who said that I should see how my fees match up to what plumbers make, and see if the work I do is proportionate to the work they do for the same amount. Interesting comparison.
The upshot of all this private billing is that it seems like charging people extra to see their doctors really seems to clean up the waitlists. Everyone here seems able to get a specialist visit within a few weeks. People don't show up as often with non-medical problems. They also listen to what they're told. Not everyone, but for the most part they're better than Torontonians. Around here, charging a little extra doesn't just get you money. It gets you respect.
Amy's noticed the same thing. Patients listen when she asks for informed consent, but they never refuse a procedure or ask questions. They just say "Do what you think is best, doc". Their attitude is that they know you're going to do your best and if a complication happens, well, that's life. Nobody meant for it to happen. Contrast this with the culture at home where if a waiter serves someone the wrong amuse bouche they expect to eat for free.
Not every aspect of this private/public system is fantastic though. Turns out an ambulance here costs $700. Sure, some of that is covered if you have private insurance but I'm sure there're a lot of people who don't have ambulance coverage.
At any rate, so far it doesn't seem like the sky is going to fall on anyone if Canadians scrapped their solely publicly funded health care system. Just don't send them the wrong amuse bouche.
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