Trach news item

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Samkl

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Last night, on one of our commercial TV networks, there was a news item about a 52 year old woman with MND, Gabe Watkin, who, with the support of her family, wants to have a tracheostomy performed. The request has been knocked back by the health service where she lives in Queensland. It highlights the different perspectives around the world (and this country!) on this procedure.
 

lgelb

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This is the story. I found the government statement that she would require 24/7 skilled care rather strange, given that in other countries, family members typically care for the trach/vent.

Best,
Laurie
 

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Yes it is nearly unheard of for PALS in Australia to have a trach.
You would have to really have the financial means to pay for assistance, it is not covered under medicare nor private insurance.
It is not perspective so much as we have so much free or very low cost health care that other countries do not have.
Traching a PALS is not part of this.
In other countries people have no choice but to pay quite large amounts for health insurance, and often to more than one provider. They then still find themselves paying out of pocket for a lot of home help for a PALS.

So when you report this, the request for tax payers to fund the trach and all ongoing care has been knocked back. I realise reading this back that it sounds like I am being a bit harsh with my words which is not my intent at all. I watched my husband die even though he felt medicare should have covered him being given a trach and full home care.
I think that 9 news are irresponsible using the emotive language in that article 'life-prolonging surgery knocked back'.
 

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Here in the US, skilled care for a trach at home would not typically be covered by insurance, either, unless something went wrong with the vent or trach. It's true that supplies would be covered, though.

The daily care and feeding is custodial care for which insurance does not pay, with rare exceptions, so it is equal in that respect. Likewise, what we pay in health insurance, I suspect Aussies may pay in taxes; I'm not sure health care is ever "free."

The reason I called out the assumption around skilled care at home is that it would indeed be very costly, and so it may be that assumption that contributes to the refusal, rather than the reality of how most P/CALS who have trachs can actually manage them. I would be curious to know if the family could offer to handle home care labor without the government's funding, but that is probably not an option in a single-payor system. Naturally, I also wonder if they have fully optimized her BiPAP settings...
 

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There have been higher profile people with money in Australia that have had a trach and vent.
 

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No doubt; bypassing the health system entirely, I presume. And in any country, the wealthy can arrange for any manner of assistance at home.
 

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Yes Laurie that is totally correct.
Also we have what is called a 'public health system' and a 'private health system'. Some hospitals are 'public' and some 'private', but to be confusing both can and do take both public and private patients. Mostly that dictates how the hospital is run and funded. So the wealthy would have this done as elective surgery within the private health system and pay for it all, and then pay for all after care and assistance at home. It is the public health system that have turned this person down as it is not designed to take on this kind of 'elective' surgery, but more so, the after care of the trached person.
A trach is placed in any emergency situation in the public system of course if someone comes into emergency for example as result of an accident. Usually that will involve an insurance claim anyway and the hospital will recoup the costs of the care.

When my Chris had ALS (and I want to note for any aussies reading this, that this was pre-NDIS days, so things have now changed in how they work), he was immediately granted a pension, and so was I as his carer, and all his care both in hospital, and at home was fully funded by our health system, including having a case manager, being registered with palliative care and having nurses come to the home.
The only cost for us was that any prescription medications cost a nominal fee of $6 each time they had to be filled (because he was now on a health care card).

While things are different now in how the funding for care at home, equipment, home modifications and vehicles is worked out, we are able to receive a lot of assistance. We also have awesome MND associations in each state that provide free services.
 

Samkl

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Apologies, I wasn’t meaning to be controversial. Just wondering how much of the reluctance to trach in Australia (and perhaps in the case I mentioned) is a cultural thing, as has been noted by Diane when she talked about the prevalence of traching in Japan, for example. I’m also profoundly grateful for the public health system in Australia.
 

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Hey Samkl, it was a great thing to bring up. I rarely talk about our health system here as it is so different to others, but I felt it was worth explaining in a bit of depth to address what you said well because it's really complex.
It is really quite impossible to compare across some cultures too isn't it?
 
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