justin bowra - the elephant in the living room
TRANSCRIPT
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A presentation in two acts
By Justin Bowra, Sydney Adventist & Royal North Shore Hospitals,
Australia SMACC 2015
The Elephant in the Living Room
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DISCLOSURE
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PROLOGUE
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PART I
The Elephant in the Living
Room
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But…
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AUSTRALIA
Health spending
1995: 7.5% of GDP
2012: 9.1%
Australian Institute of Health and Welfare
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USA
1995: 13.3%
2012: 17.9%
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AT THIS RATE…
2050
Australia 13%
USA 25%
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What’s going on?
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Ageing population?
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Better treatments?
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‘On average, a 50-year-old now is seeing
doctors more often, having more tests and
operations…’
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‘Health systems themselves are
becoming a threat to society’s
wellbeing.’Atul Gawande, Reith lectures
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Doctors
Government Special
interests
Hospitals
Insurers Lawyers
Consumers
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Doctors
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Plumbers
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PART II
Fixing the system
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Doctors
Government Special
interests
Hospitals
Insurers Lawyers
Consumers
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Doctors
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HOW CAN THE
ELEPHANT HELP?
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1. Look at the big picture
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2. End-of- l i fe discussion
about the healthcare budget
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3. Sur render some
autonomy
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1. Look at the big picture
2. Shared decision making across society
3. Surrender our autonomy
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A challenge
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FINAL THOUGHT
‘Business as usual’ is not an option
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THANKS
Rob Day, Mark Gillett, Cath Herlihy, Sally
McCarthy, Stella McGinn, Larry Melniker & Nick
Stow
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REFERENCES
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Armstong K, Tess D. Fault versus No Fault- Reviewing the
International Evidence. Institute of Actuaries of Australia
Seminar, 2008.
Dartmuth Atlas of Healthcare http://www.dartmouthatlas.org/
Gawande, A. Reith lectures
Gawande, A. The cost conundrum. New Yorker, June 2009 [link]
Godlee, F. Tackling practice variation. BMJ 2011. 342:d1884 [link]
Gortmaker SL, Bickford AF, Mathewson HO, et al. A successful
experiment to
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Kennedy PJ, Leathley CM, Hughes CF. Clinical practice variation. Med J Aust.
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Oberlander J et al. Rationing medical care: rhetoric and reality in the Oregon
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http://americannewsreport.com/arthroscopic-knee-surgery-
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