Dr. Hensley: Every Australian patient has their own Medicare number and they can all get access to the system. The clerks also have 100 percent access the Medicare information they need. I can see what the patient has had to a degree on a kind of an HTML-based system. The hospital does not feed data to that. That just has their Medicare claims results. So if they’ve had imaging tests, I can see that, but it doesn’t indicate the results. It just has tests they’ve had and other conditions.

Our system here in Bunbury, Western Australia, is different than the system in Perth, is different than the system in Sydney and I can’t see their notes, but all the systems in Sydney can see each other. A lot of the systems in Perth can see each other. In Bunbury, we were attached to a private hospital, which is a unique amalgamation of what happens when you have publicly insured people and privately insured people in the same town. If we sent patients over there, all of our cardiac patients went over there, we couldn’t see any of their notes. If they got discharged and came back to our emergency department the next day, we couldn’t see anything. So it’s great on the billing side, it makes everything real efficient, smooth, and fast. Does not mean I can see their actual health care record.

In the United States, we’re heavily focused on the Emergency Medical Treatment and Labor Act (EMTALA). In Australia, are people ever referred away to another facility without being seen? Does that scenario happen?

Dr. Hensley: We don’t have to do any examinations or other types of things that you would normally feel you would need to do in the U.S. to kind of cover yourself from a malpractice lawsuit standpoint. You can tell the patient, “I’m not the proper person for it. You need to go see your general physician (GP) tomorrow,” and you can just sign them out and they leave.

They can still have trouble getting in to see their GP and it may take a couple more days than usual, but every Medicare patient here has a GP. There aren’t people here that don’t have primary care physicians. It’s glorious. The issue at play sometimes is geography and other things, like in the U.S., if you need somebody that has a specialized problem—hand surgery, ophthalmologic surgery, or something kind of specific—a specialist will see them in the U.S. because there’s EMTALA. In Australia, they’ll say either the patient needs private insurance or they’ll need to pay our fee schedule.