John Dwyer

Professor John Dwyer AO, is an Immunologist, Emeritus Professor of Medicine at UNSW and for many years heavily involved in efforts to improve the delivery of healthcare in Australia. He was the founder of the Australian Healthcare Reform Alliance.

John's recent articles

JOHN DWYER. Punishing and jailing the mentally ill.

A 37-year-old Sudanese woman has been sentenced to 26 years in jail for murdering three of her children by deliberately driving her car into a lake. The story is a tragic one and has nothing to do with criminal behaviour. It raises, yet again, the appalling way in which we treat those with a seriously mental illness who, while ill, break our laws.

JOHN DWYER. Policy mayhem is stifling efforts to have more Australian doctors "in the bush" - part one

In this two part article, I am reviewing the basis for the serious problem we have in providing adequate health care for Australians who live in rural, and particularly, remote areas. Good intentions are, as ever, intertwined with political machinations which make policies for solutions harder to implement. Currently, yet another government review is soon to be released. Here is the background needed for judging the results.

JOHN DWYER. Policy mayhem is stifling efforts to have more Australian doctors "in the bush" - part two

In this two part article, I am reviewing the basis for the serious problem we have in providing adequate health care for Australians who live in rural, and particularly, remote areas. Good intentions are, as ever, intertwined with political machinations which make policies for solutions harder to implement. Currently, yet another government review is soon to be released. Here is the background needed for judging the results.

JOHN DWYER. The parlous state of strategies to protect consumers from health care fraud. Part 3 of 3.

Credible scientific evidence of clinical effectiveness should underpin the delivery of health care. Satisfactory health outcomes and cost effectiveness require this approach. In Australia however pseudoscience flourishes as regulatory bodies fail to protect consumers from health care fraud.

JOHN DWYER. The parlous state of strategies to protect consumers from health care fraud. Part 2 of 3.

Credible scientific evidence of clinical effectiveness should underpin the delivery of health care. Satisfactory health outcomes and cost effectiveness require this approach. In Australia however pseudoscience flourishes as regulatory bodies fail to protect consumers from health care fraud and a massive industry prospers as it convinces consumers to use expensive supplements they do not need. In this three part examination of the issue the extent of the problem is examined, as are the changes that would better protect consumers.

JOHN DWYER. The parlous state of strategies to protect consumers from health care fraud. Part 1 of 3

Credible scientific evidence of clinical effectiveness should underpin the delivery of health care. Satisfactory health outcomes and cost effectiveness require this approach. In Australia however pseudoscience flourishes as regulatory bodies fail to protect consumers from health care fraud and a massive industry prospers as it convinces consumers to use expensive supplements they do not need. In this three part examination of the issue the extent of the problem is examined, as are the changes that would better protect consumers.

JOHN DWYER. A shared vision for restructuring primary care in Australia.

At last the clouds are dispersing, the sun is shining through and one can see a splendid vision of a restructured primary health system that meets the needs of contemporary Australia. For the first time that I can remember, there is a consensus among informed consumers and health professionals that enthusiastically supports the introduction of Patient-Centred Healthcare Homes as the primary care model we need to deliver cost effective and equitable integrated primary care. The model has been or is being implemented in eleven OECD countries and the results are most encouraging. Just published is a position paper from a...

JOHN DWYER. Medicare and the 45th Parliament.

Clearly the future of Medicare was the election issue of greatest importance for most Australians. Community concern was focussed on the possibility that the primary care they receive from their general practitioner might be privatised such that a superior service would be available to those who paid more, either directly or though the extension of private hospital insurance to allow for coverage of GP services. This was never going to happen but its important to understand what it was that had stimulated discussion of the possibility. Private health insurers, who are not permitted to cover services provided with Medicare dollars,...

JOHN DWYER. Restructuring the governance of health care in Australia. Part 1

Part One. Structural reforms for better health outcomes from a redesigned more cost-effective health care system. The most important pre-election health care initiative has received very little publicity. Labor has committed to establishing a Healthcare Reform Commission if elected. While not likely to generate much discussion in ones local pub it represents an acceptance by a major political party that we do need to explore structural changes to the way we deliver health to achieve better outcomes and fiscal sustainability. What follows is an evidence based scenario for the evolution of major structural reforms, many of which are currently...

JOHN DWYER. Restructuring the governance of health care in Australia. Part 2

Part Two. Structural reforms for better health outcomes from a redesigned more cost-effective health care system. There is broad agreement that in the near future our General Practitioners and their teams will earn the majority of their income from capitation payments that will require, for the first time in our Primary Care system, the documentation of health outcomes. Many doctors are concerned about this direction and argue that they may have neither the time nor the necessary kills to fulfil such requirements. International experience informs us that these doubts can be reversed with the creation of Primary Health Care...

John Dwyer. Structural reforms to healthcare - two major reforms.

Does the government understand the structural reforms to health care needed by modern Australia? Political pre-election posturing at the moment has involved many debating the question that asks Do we have a spending or a revenue problem in Australia? Certainly when it comes to our health system we should first be asking what structural reforms would make that question less important. While the idea that States could tax their citizens to pay for hospital care vanished in a flash, there is a distressing significance to the idea ever having been floated in the first place. It means that...

John Dwyer. 'Health' products and treatments that are often unproven and sometimes dangerous.

Health Care Advertising and Consumer Protection There are far more irritations than pearls available currently to those of us trying to champion the importance of having our health care underpinned by credible scientific evidence of clinical effectiveness. Though we live in the most scientific of all ages it is cause for concern that practices based on pseudoscience remain so entrenched in our community. Consumer protection from misleading often-fraudulent advertising and unscientific ineffective practices is distressingly inadequate. For those concerned about this situation, the pleasure from watching the Australian Open Tennis championship on TV is diminished by the plethora...

Why we don't want private health insurance for primary care

The worst possible outcome from the current review of Private Health Insurance would be changes that resulted in the best-resourced Primary Care being only available to those who have such insurance.

John Dwyer. Wasting precious health dollars.

In the last eighteen months our coalition government has repeatedly warned that the rate at which we are increasing health related expenditure is unsustainable. The attempt to extract a co-payment from Australians visiting their GP was justified using this concern. However it is the better use of the currently available health dollars that should be given priority rather than asking Australians pay more for a health system that no longer adequately meets contemporary need. It is true that a considerable amount of the cost ineffective expenditure on health is generated by members of my profession with low value and sometimes...

John Dwyer. An increase in the GST or efficiency gains to fund our hospitals. Which would you prefer?

Premier Baird has announced that he will require a 15% GST to fund our public hospital system in the coming years. It is certainly true that with present policies, revenue wont match the cost of the anticipated future demand for hospital care. Hospital admissions climb steadily each year (average increase 3%) and the additional patients tend to be sicker and older. Our current health system puts pressure on our State and Territory governments to constantly find more beds and provide new hospital stock. Without financial restructuring his government will not be able to provide us with the quality service we...

John Dwyer. Pseudoscience and health care.

Current Affairs The catalyst for my need to share with you frustrations associated with the penetration of pseudoscience into Australian health care and the poor protection of consumers from same, was generated by the release of the details of the long awaited Free Trade agreement between Australia and China. We now know that Chinese medicine was the subject of a side letter from Australia's Trade Minister, Andrew Robb, to the Chinese government, which outlined plans to strengthen cooperation on traditional medicine, which among other things, could open the door for hundreds of contractual service providers from China to be...

John Dwyer. Politics trumps health policy yet again.

Current Affairs. Health. A new medical school in Perth will create more problems than it will solve. As must also be true for many colleagues who have been focussed on evidence based solutions to the serious shortage of Australian trained doctors working in rural communities, I am frustrated and annoyed by the Prime Ministers capricious decision to fund a new medical school in Perth. In an attempt to solve the maldistribution of Australian trained doctors that has resulted in almost 50% of the General Practitioners available to people in rural and remote communities having been trained overseas, governments have...

John Dwyer. Sliding down the slippery slope to two-tiered health care.

Private Health Insurance gets a foothold in primary care. Imagine the following scenario. You are checking in with your GPs receptionist for your scheduled appointment and are asked to produce your Medicare Card and, if you have one, your private health insurance membership card. If you have both you move into the waiting room on the right reserved for patients with private health insurance for whom the practice will provide a range of additional services not available to those in the waiting room on the left. Health outcomes are resource dependent so patients who can expect more quality time with...

John Dwyer. Health Policy Reform Commentary - Part 2

In the first part of my commentary on John Menadues Health Policy Reform in his blog, I discussed the barriers frustrating any reform agenda. In this second part I will comment on John Menadues suggestions for overcoming these obstacles to health reform and provide my own thoughts on what a reformed health system might look like. In his blog he commented that seldom do we stand back and ask the central issue: what do we need and expect from a health system? For some years now I have presented the following answer to that question to professional...

John Dwyer. Commentary on John Menadues blogs on the barriers to health policy reform in Australia. (Part 1)

As I suspected would be the case with many readers who enjoy Pearls and Irritations, I experienced in equal measure, satisfaction and frustration as I absorbed John Menadues informed and insightful analysis of the problems that beset our health system and prevent urgently needed structural reforms. His three essays accurately explore the major issues. He has experienced political power and politicians motivations from the inside. Fortunately, his passion for good government has, for two decades or more, been particularly interested in improving our health system. Here too, importantly, he has had first hand experience of how the system works (and...

John Dwyer. Medicare changes - why on earth would a young doctor want to be a GP?

In case you missed it, this is a repost of a blog that I posted on 12 December last year. It is highly relevant to the continuing debate about copayments and general practice. John Menadue. The most distressing feature of the governments determination to have us pay more for a visit to our GP is its the total lack of vision for the structural reforms we should be discussing to provide Australians with Primary Care services that meet contemporary needs, are equitable and more cost effective. Instead of focussing on new models of care that around the world have...

John Dwyer. The structural reform of Medicare rather than its funding is the real challenge.

Part 2: Attracting the future work force needed to provide Primary Care. There is another imperative for introducing Integrated Primary care (IPC),the new model of primary care described in part one of this review; the recruitment of the next generation of GPs. Recent surveys of the career intentions of medical graduates show only 13% are interested in a primary care career and only 13% of them have any interest in working in rural Australia. They see that 70% of GPs do not want to be tax collectors for the government and note that the Medicare rebate for a...

John Dwyer. The structural reform of Medicare rather than its funding is the real challenge.

Part 1; The model of primary care we need for contemporary Australia. For months the federal government has been telling us that a mandatory co-payment for a visit to our GP was essential to afford the $19 billion we currently spend on Medicare each year and projected increases. There would be an added benefit in that the payment would send a price signal to remind Australians that such visits can no longer be free. Too many of us are visiting our doctors too often! Additional revenue would be generated by a seven-dollar co-payment for prescriptions, pathology and imaging. Given...

John Dwyer. Primary healthcare in Australia reaches the crossroads.

When I graduated some 50 years ago more than 50% of my class pursued careers as General Practitioners. In the last available survey of the career intentions of graduating medical students only 13% said they were interested in Primary Care and only 13% of those who would consider a career in rural Australia. Currently more than 45% of the General Practitioners available to rural based Australians are overseas trained doctors most of whom are working there as provider numbers were not available for metropolitan practice. The average age of working General Practitioners is 55 years. Young doctors considering vocational...

John Dwyer. Cutting waste and costs in health.

Tactics and strategies for a six year journey to sustainable, equitable excellence (1) Move to a single funder for our national health scheme (The Commonwealth). The funder would contract with States and other potential providers to deliver integrated patient focused care. The health bureaucracy would be reduced by 80% with greater efficiency, better outcomes and less duplication saving at least $ 4 billion per year. (2) Remove Tax-payer support for Private Health insurance. Health Insurers are making large profits. Australians will retain their PHI as other sticks make that a certainty. The introduction of the subsidy saw PHI increase...

The mooted $6 fee for GP visits trivialises the problem. Guest blogger: John Dwyer

There is a lot that is disturbing about the federal governments flirtation with a $6 co-payment for a service from a GP. Most commentators have rejected this approach as poor public policy as it will act as a deterrent for poorer Australians to seek the care they need to provide paltry savings in a 120 billion dollar a year health system. This policy will cost all of us dearly as avoidable chronic illness among those less economically secure already absorbs so many of our tax dollars. With the exception of illness caused by excessive alcohol consumption, all risk factors for...

No vision for the health system we need. Guest blogger Prof. John Dwyer

In this election the Coalition has provided dollar promises for worthy projects but no new health policy initiatives while only two of note have been forthcoming from the government; a long-term investment in stem cell research and the threat to remove family tax benefits from parents who put their children and the community at risk by not immunising them. Both are laudable but of greater interest to Australians would be our politicians plans for solving the many problems that compromise the delivery of sustainable quality health care in our country. In a recent survey Research Australia found that funding for...

Health care reform remains a prisoner of Federalism. Guest blogger: John Dwyer

The intractable problem that sees a very wealthy country unable to provide cost effective and equitable health care is a political one. We are the only OECD country in which the provision of health care is illogically and inefficiently divided between two levels of Government. The Federal government is charged with funding, but not providing, Primary and Community care. The State governments are both funders and providers of our public hospital system and endless arguments (the blame game) revolve around the adequacy or otherwise of the contribution to hospital care from the Commonwealth. So 22 million people are served by...

<