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I had left the Australian summer to intern with NWHN and spend time with my sister, and from the minute I stepped off the plane I found myself constantly (and [...]

Australian healthcare has a mismatch between its capacity to deliver quality healthcare and the changing demands of the community. Australian healthcare reform is in need of political champions and cooperative federalism to harness people and professional power.

The medical recording process requires to become more efficient as it provides a line of communication between clinicians and health services. The coders require accurate, comprehensive medical records expressed in a predictable format to produce quality data.

The health of the Indigenous Australians continues to be a neglected area. The presence of Indigenous Australian students in the medical schools provides a ray of hope for dealing with Indigenous health.

Australia's Quality Use of Medicines (QUM) program is central to the National Medicines Policy, and has had a good impact on medical practice in Australia, leading to a number of publications and other innovations to improve the prescribing of medicinces. But the Pharmaceutical Benefits scheme (PBS) has focused on cost cutting, not on the quality use ofmedicines. A forum for open debate of QUM issues is needed.

Rehabilitation medicine, which was recognized in 1978 as a principal specialty in Australia and in 1991 as a Faculty of the Royal Australian College of Physicians, was developed in response to manage disabilities which were a result of road and occupational trauma and wars. A higher incidence of disabling conditions (such as fractured femur or stroke) and ageing populations are two of the many reasons that practice in rehabilitative medicine is important today.

In Australia, an increase in costs of diagnostic testing in radiology and pathology in Australia shows that there is too much focus on empirical tests over clinical acumen. Unnecessary imaging and pathology testing further drives up the cost of healthcare and impacts services that are necessary. Studies show that an alteration in the process oftest ordering produces better results, and changes in management strategies and point-of-care guidance and feedback systems should be further investigated.

A fictional piece illustrates how general practitioner's usage of information technology such as laptops, the internet, e-mail, and telecommunications can help enhance medical care in Australia.

Susan Wearne, who resigned as a general practitioner (GP) in York, England in July 2000 to work at the Centre for Remote Health in Alice Springs as a GP Educator, recounts the differences and challenges between the two fields. One of the biggest challenges about working with the Aboriginal culture is an absence of a shared common language makes it harder to convey an understanding of a problem between patient and doctor. Susan's coping changes has taken time and patience, but the end result has made it all worthwhile.

Current requirements for case conference, a tool which is used to coordinate, assign interventions and identify the needs of patients with chronic conditions care across a multidiscplinary team, is regulated by the Ehanced Primary Care (EPC) package which was introduced by the Commonwealth Government in 1999. Some of the requirements under EPC are eligibility, what should be done, what the obligations to the patient are, and how often a case conference can be held. The main problems practitioners face under these guidelines are logistical in nature due to the complex procedures which must be followed.

Adequacy of the general practice (GP) workforce, which was once measured by crude doctor-to-population ratios in comparison to other countries, is now measured with lifestyle choices, supply-side issues, length of training and the femininization of the workforce taken into account. Access Economics developed a model which analyzes general practice supply and demand with econometric tools and found that Australia currently has a shortage of GPs in both rural and urban areas. In light of an ageing population, the Federal Government, which influences doctor numbers, must come up with a plan to achieve an adequate number of doctors in the workforce.

Australian Aboriginals and Torres Strait Islanders have high mortality rates, but they underutilize specialist healthcare. Part of the problem must be an inherent, if unintended, bias against providing health care to Aboriginals. The decision-making process should be reviewed to try to determine why Aboriginals are not getting optimal health care.

A description is presented of the work which is carried out by nurse Annelies Cusack who is a member of the Australian Royal Flying Doctor Service. The primary health care which she provides is discussed.

Generic issues in the implementation of guidelines emphasizing continuity of care between hospital and community are discussed.

Issues concerning the value of the medical emergency team (MET) system compared to the cardiac resuscitation team in Australian hospitals are discussed. The MET can be called to treat any very ill patient by a ward sister.

Issues are presented concerning the inability of Medibank and Medicare to fund the increasing costs of advanced surgical procedures or to meet the public's demand for surgery.

Issues are presented concerning the need to rationalize health care to affordable levels. The difficulty of deciding priorities in the provision of health care services is discussed.

Issues are presented concerning the establishment of the Medibank and Medicare health systems. The public's response to the concept of free access to medical services, irrespective of income, is discussed.

Issues are presented concerning the impact of the establishment of the health care system Medibank on general medical practices. The overservicing compensation of general practitioners by current rebate levels is discussed.

Issues are presented concerning the change in attitude of the medical profession who now support the principles of health care access for all citizens irrespective of income.

Issues are presented concerning the effect on general medical practitioners of the establishment of the health care system Medibank. The management of the general practice system before Medibank was established is discussed.

Issues are presented concerning the effect of the health care system Medibank on the practice of medicine in rural areas. The resistance of medical practitioners to bulk billing is discussed.

Issues are presented concerning the campaign fought by the Doctors Reform Society in the 1970s in support of the concept of Medibank, which promoted health care access for all citizens irrespective of income.

Issues are presented concerning the campaign which was fought by the Australian Medical Association against the health care system Medibank in the 1970s. The nationalization of the Australian health service in 1974 is discussed.

Issues are presented concerning the campaign of the Australian Medical Association (AMA) against the health care system Medibank. Although the AMA was successful in forcing change it was unable to prevent the continued existence of Medibank.

United States Surgeon-General David Satcher plans to help improve Aboriginal primary health care delivery with education as the catalyst. Satcher's plans stem from his visit to South Australia, where Aborigines face a variety of health problems such as alcoholism, renal failure and a life expectancy 20 years below the average non-indigenous Australians.

Increased integration of public and private and Commonwealth and State medical services in Australia, guided by health care delivery research, may most effectively improve acute-care hospitals. Historical divisions of service promote inefficiency and discourage hospital competition. General practitioners may become central to community health delivery, while hospitalists assume a key role in inpatient medicine. Thoughtful policy evaluation, planning, modeling, and decision analysis will guide health care planners to identify the hospital's role in the future.

Australia's health care system meets comparable standards in terms of quality care, access to services and doctors, however the financial structure of the system needs addressing. The cost are expected to rise. The problem will escalate as politicians continue to patch the system without addressing long-term issues.