Death, be not proud

The release of Australian mortality data by the AIHW brings to mind Donne’s sonnet, although causes of death are no longer the ‘kings and desperate men‘ attributed in c.1610.

In 2017, there were 160,909 deaths registered in Australia, 66% among people aged 75 or over (60% males and 73% females). The median age at death was 78 years for males and 85 years for females. 

Overall, cancer (neoplasms) was the leading cause of death. At 29%, clearly easing circulatory diseases (27%) out of the top spot for the first time. The leading cause of death for males was coronary heart disease (13%). Dementia and Alzheimer disease was the leading cause of death for females (11%), followed by coronary heart disease (10%). Cerebrovascular disease (which includes stroke), lung cancer and chronic obstructive pulmonary disease (COPD) made up the top 5 leading underlying causes of death in Australia in 2017 for both males and females of all ages combined.

In 2017, the difference in death rates between the sexes was the narrowest ever recorded. The greater than 70 % reduction from a high in 1968, is considered to be due to a drop in deaths from circulatory diseases. Factors at play include improvements in medical care (surgery, diagnosis and pharmaceuticals), and lifestyle changes (smoking, diet and high blood pressure).

Child (aged 0-4 yrs) mortality accounted for < 1 % of all deaths in the period. A major improvement on the 26 % reported for 1907, however still too high for the families involved. Work continues on access to and quality of neonatal health care; community awareness of risk factors; and increasing coverage of universal immunisation programs.

As well as differences by gender, the leading causes of death also vary by age (refer graphic):

  • Among infants, perinatal and congenital conditions accounted for 79 % of deaths;
  • Land transport accidents were the most common cause (11 %) among children aged 1–14 .
  • Suicide was the leading cause of death among people aged 15–24 (35%), followed by land transport accidents (22%);
  • For people aged 25–44, it was also suicide (21%), followed by accidental poisoning (12%);
  • Chronic diseases feature more prominently among people aged 45 and over. Coronary heart disease was the leading cause of death for people aged 45–64, followed by lung cancer;
  • For people aged 65–74, it was lung cancer followed by coronary heart disease;
  • Dementia and Alzheimer disease was the second leading cause of death among people aged 75 and older, behind coronary heart disease.
Leading underlying causes of death, by age group, 2015–2017 (AIHW Figure 3.2)

Image: An Unclean Death by Pia Guerra

In defence of Private Health Insurance?

Having been hit by the proverbial bus (#), although in my case, it was a toboggan, my recent encounter with the Australian healthcare system has left me in awe!

From the impromptu consultation with a holidaying ER specialist; the ordered chaos of the Perisher Valley Medical Centre; the administrative whiz at the Sydney rooms who got a specialist to look at my X-rays, found an early morning appointment followed by an emergency MRI slot. This on the way to the hospital to prepare for surgery, by the said surgeon who added me, along with 2 other ‘urgents’, to the list. The hospital nursing and other staff were as competent and professional. A simple thank you seems inadequate.

Once on the list, the private hospital called to inform me that my PHI fund had agreed to pay for my stay. All I would need to pay was the $450 excess (a trade-off applying to each separate admission for some fee relief). The actual admission process was reminiscent of those scenes from American movies where the parent/partner finds out the very expensive care that his/her loved one needs is not covered by insurance.

I was out of pocket every step of the way. I was well informed upfront as to what costs were likely to be involved. Except for the anaesthetist (and assistant surgeon), whom introduced themselves and then promptly injected me with a cocktail of medicines that mean I can’t remember a thing!

What is one to do in this situation? I didn’t explore the possibilities of not being able to pay the gap between what was being charged and the Medicare scheduled fee. To avoid an out of pocket I would have needed to be driven to a medical service in Jindabyne (35 km) or even Cooma Hospital (100 km) emergency department for the initial consultation and an X-ray. Is it a part of Australian folklore that everyone should be bulk billed at a GP level?

The Australia Medical Association Guide for Patients on How the Health Care System Funds Medical Care (2015) notes that:

  • ‘The Medicare Benefits Schedule (the MBS) is a list of the medical services for which the Australian Government will pay a Medicare rebate, to provide patients with financial assistance towards the costs of their medical services.
  • Medicare rebates do not, and were never intended to, cover the full cost of medical services.
  • Medical practitioners are able to set their own fees for their services.
  • The MBS fee and the Medicare rebate do not reflect the value of a medical service or an amount that medical practitioners should or must charge.’

The same applies to specialist medical fees, as consultations and procedures are covered by Medicare, not PHI. Again, where a gap exists, it must be filled by the patient.

Is PHI being unfairly blamed as the cause for all the gaps and out of pockets, when maybe Medicare was never meant to be as universal as we all wish it was?

I will revisit once all the invoices have arrived!

# with reference to Jenna Price SMH 19 July 2019