We, as a nation, have always prided ourselves on the quality, accessibility and affordability of our health system. Particularly when we make comparisons to the cost of the system in places such as America etc, we come out looking particularly strong. The Health Department makes the following statements on its website:

  • Australia’s health system is world class, supporting universal and affordable access to high quality medical, pharmaceutical and hospital services, while helping people to stay healthy through health promotion and disease prevention activities.

The Department of Health has a diverse set of responsibilities, but throughout there is a common purpose, which is reflected in our Vision statement:

  • Better health and wellbeing for all Australians, now and for future generations.

We have all accepted that these statements are reflective of the reality in Australia and all of those people who require health care services will have access to them. So it was a surprise when I read the press release put out by Ricky Buchanan recently. In part that release said the following:

“The Australian medical system has comprehensively failed those people who find it difficult or impossible to leave their homes, according to a report released today.

The report, “Just Invisible: Medical Access Issues for Homebound/Bedridden People” examined homebound and bedridden people who are excluded from all facets of the medical system, including GPs, specialists, hospitals, and allied health. This exclusion also results in an inability to receive the paperwork necessary to access other supports such as Centrelink and NDIS”

Ricky Buchanan, the author of the report explains, “There are no patient groups, peak bodies, or advocacy organisations that specifically represent homebound/bedridden people. As a person who has been homebound for 20 years (and in all that time there has been no advocacy around this), I felt compelled to do this.

People become homebound/bedridden from a variety of diseases, including Multiple Sclerosis, ME/CFS, ALS, complex spinal cord injury, ABI, and severe mental illness. Many elderly people are also homebound/bedridden near the end of their lives. Despite this, there has been no epidemiological research conducted on this population. Therefore, we don’t know basic facts about them. Even data around reasons for being homebound/bedridden are sparse at best.

Ms. Buchanan added “There’s no understanding. If you don’t turn up to a medical appointment they assume you don’t want the service. If you try to explain you can’t get there, people just don’t understand. They think you could come back next week or month. Trying to make people understand that it is physically impossible for you to go there, that you need them to come to you … people just don’t get it”

When you drill down to identify exactly what the problem is, it becomes apparent that the following holds true:

“This problem is that the entire medical system has been designed and based around physical attendance, and that it treats non-attendance almost exclusively as a problem of patient noncompliance. There are a few small tweaks to make exceptions for people in rural and remote areas, and some even smaller tweaks for people who live in aged care, but in the main if you are homebound/bedridden and you live in the community, then the healthcare system treats you as if you do not exist and should not exist.

In the cases where a homebound/bedridden person is well accommodated, it is not because the healthcare system is working well. It is almost exclusively because someone has gone deliberately out of their way to help, and they will probably not be adequately compensated by Medicare or any other government system for doing so.”

What this report highlights is that the statement at the very start of this article in describing the Australian Healthcare system is not entirely true. There is a whole cohort of people who are those who are homebound that will not be able to access the system. The system is also predicated on the physical attendance to access this healthcare. The report is sending a very important signal to our policy makers and bureaucrats. And that message is that we need to re-examine the issues of access to healthcare in this country.

The report concludes with the following comments to health care professionals:

“The good news here is that because there has not been any advocacy around this area before, there are several “low-hanging fruit” in the recommendations – things that governments, hospitals, doctors, and RACGP could quickly implement at fairly low cost to them. These things, such as basic education around homebound/bedridden issues for all medical professionals, and extending existing Telehealth systems to cover homebound/bedridden patients, could have a big impact on the wellbeing of homebound/bedridden patients. We need to do this”

As a person who has argued issues of accessibility to health and disability services for a considerable amount of time, I urge policy makers to read the report and engage with Ms Buchanan to make sure that our systems do not forsake this cohort of people who need to have access to the system. The report can be accessed here: http://notdoneliving.net/justinvisible/