The medical boom: hospitals post war

Over four weeks ROLAND ROCCHICCIOLI is looking at different aspects of our health care. Last week it was chronic disease still to come are the system itself and health insurance.

 

From a patient’s perspective, it was a time of comparative medical security.

 

IN the 1950s you did not need an appointment to see the GP.

You made your way to the surgery, waited your turn to be seen, and he sent you the bill. While it was not perfect, it was a public health system to be admired.

From the 1940s though to the 1960s undergraduate medical course for GPs was six years. While some may have worked as regional medical officers in the hospital system, an internship was not mandatory.

In country town district hospitals, a permanent doctor, matron and nursing staff ran the hospital and worked together in the surgery and the operating theatre.

Most doctors were physicians and surgeons. For any major surgery an available fellow GP administered the anaesthetic, or he worked alone, assisted by the matron.

Ether or chloroform was regulated by checking the patient’s pupils. Occasionally the patient woke-up in the middle of the procedure.

GPs removed tonsils and appendix, and delivered babies, including caesarean sections.

Ultimately, a threefold insurance premium increase ended the system.

Dental procedures – extractions only – were commonplace, and in emergencies they helped-out local farmers with a veterinarian requirement.

Most days GPs saw up to 40 surgery patients and made as many as 25 house calls. They worked weekends and public holidays.

Large regional practices operated with up to three independent doctors and a receptionist.

Others practiced singly. Major hospitals – public and private – were on a performance standard with their city colleagues. Only the more complicated and rarest of cases were transferred for treatment.

With advancing technology, and the availability and effectiveness of drugs, specialists’ diagnoses and treatments of conditions improved.

Increasingly, specialists’ exclusive management of hospitalised patients, and the hubristic belief of better training, saw some decline in the status of general practice.

Specialists’ income and stature flourished.

According to Ben Harris, a health policy expert, Victoria University’s Mitchell Institute, steep fees charged by specialists is another barrier to health care, together with long waiting lists at public hospitals.

By the end of the 1950s almost 85 per cent of the population held private – not for profit – health insurance; many received benefits from pensions, or as war veterans.

On average, health fund membership fees cost two shillings and six-pence (25 cents) a fortnight from a basic wage of $45 a fortnight.

Simultaneously, community lodges and friendly societies were established. Membership fees were used to pay doctors an annual capitation fee, guaranteeing no charge to the patients.

Initially successful, a failure to negotiate on-going terms led to GP disenchantment and an end by the 1960s. GPs began billing direct. Those who could not pay were treated gratis.

At the end of World War Two, Australia’s population was 7.4 million. In twenty years, the post-war migration program coupled with the baby-boom increased it to 11.39 million – a tripling of the average population growth.

As the numbers grew, so, too, the need for new residential suburbs and related infrastructure, including hospitals.

Consequently, Australia underwent its second major hospital construction boom. Many central-city hospitals were relocated to suburban sites closer to their patients.

Radical hospital operational changes were not without consequences.

It has been mooted cost-cutting reductions of permanent cleaning and domestic staff may have provided a breeding ground for staphylococcus aureus better known as golden staph.

Corporate profit and management salary incentives have resulted in a reduction of some patient services.

In Ballarat, a senior honorary obstetrician withdrew his services following a dispute over a portion of bread, jam and butter.

The obstetrician asked management for the simple fare to be left in a fridge on those occasions he was called-in at night for long and complicated deliveries.

The request was refused, and it took six months to resolve the impasse.

Medically, the 1970s proved a watershed. Total health expenditure of $683 million in 1961 almost tripled to $1.7 billion.

In 1975, Medibank health insurance scheme was launched, ostensibly to resolve all patients’ and doctors’ health insurance/treatment challenges. It proved unsustainable and was dissolved in 1981.

Applauded when reinstated in 1984, Medicare is now a complicated behemoth which is, slowly but surely, collapsing under the weight of its own inertia.

General practice underwent a debatable revolution.

Geoffrey Edelsten successfully pioneered lucrative corporate, for-profit, GP clinics employing up to 250 doctors. Pathology and radiology referrals to facilities were strategically placed in the same building and created a healthy, flow-on revenue stream.

Edelsten sold-out in 2011 for $200 million.

In 2020, The Royal Australian College of General Practitioners reported GP ownership down to 25 per cent, with two corporate groups operating more than 400 medical centres.

Australia is on the verge of becoming a two-tiered, general practice, health system disadvantaging those who cannot pay; and the problem is worsening, worryingly.

From a patient’s perspective, it is reason for significant concern.