Published in The Australian today, this powerful piece by Bill Bowtell AO offers a personal account from one of Australia’s most respected health policy strategists — not in his usual role as an advisor or policymaker, but as a patient.
Following a serious spinal injury earlier this year, Bill shares his six-month journey through the health systems of New Zealand and Australia, including his time as a Medibank customer and Amplar Health patient. His story is a compelling reflection on the care he received beyond hospital walls, and a reflection of the health transition we're witnessing in Australia— one that reimagines how we deliver care in the home and community, not just in hospitals.
A broken neck but a strong system. Bill Bowtell, AO
In the emergency room at Christchurch Hospital, the doctor stitched up the deep gash on my forehead, sent me for a CAT scan and delivered the results: “You’ve broken your neck.”
On January 2, I had been reading on a garden bench at one of New Zealand’s most idyllic country properties about two hours by road from Christchurch. As I stood up, I stumbled on a shallow step. I attempted to regain my balance but pitched head-first into the jagged rock wall of a nearby garden planter. As I rebounded from the collision, I flipped my body so that I landed on my back rather than face down. This instinctual decision probably saved my life.
My friend David saw me fall. As he arrived to help, I knew I had done serious damage, but thankfully I wiggled my fingers and toes, relieved I hadn’t severed my spine. Recalling the recent documentary on Superman Christopher Reeve’s accident, I knew how critical the first minutes were after a serious blow to the neck.
Out of kindness and concern, I knew my friends would try to shift me to a more comfortable location. “Don’t move me”, I said to David, “even if I pass out.” So began my six-month journey through the health systems of New Zealand and Australia.
In the 1980s, I was chief of staff to Dr Neal Blewett, the Hawke government health minister who introduced Medicare in 1984 and fashioned the Australian response to HIV/AIDS.
Medicare (and its New Zealand equivalent) is based on the principle that access to health care is a universal human right that should be available to all based on clinical need not capacity to pay. But the grand promises are one thing and delivery quite another. What matters is the quality of care delivered to those who need it.
This year, I went from grand strategist to humble patient. In my hour of need, how did Medicare deliver? In two words, wonderfully well. About 90 minutes after my fall, the ambulance arrived from Christchurch. Taking meticulous care of my neck, the paramedics carefully levitated me off the ground and into the ambulance. Two hours later, I was admitted to Christchurch Hospital. The CAT scan showed I had badly fractured the C1 and C2 vertebrae. Breaking the lower vertebrae and spine can result in paraplegia or quadriplegia. But the nerves that run through C1 and C2 control breathing. If they are broken, death follows rapidly. It was my good fortune that Christchurch Hospital has one of the two best spinal units in New Zealand.
The morning after I was admitted, the director told me that while the bad news was I had broken my neck, the good news was that I was alive, my spine was not damaged and that I would not require surgery. Surgery would forever fuse the upper vertebrae at the cost of losing all flexibility in my neck. While fractured, the broken bones remained in alignment. By not moving after I fell, the alignments had been maintained. To allow the fractures to heal, I would have to wear an immobilising neck brace 24/7 for four months. I was down, but not out.
Over the next two weeks the remarkable staff at Christchurch Hospital stabilised my injuries and helped me to adjust to the neck brace. Thanks to the Australia New Zealand Reciprocal Health Care Agreement, the costs of this urgent care were fully covered.
After two weeks, I was ready to return to Sydney. While the urgent phase had passed, several months of greatly restricted mobility now stretched before me. From being self-sufficient, energetic and independent I had to adjust to new and truncated routines of walking, sitting, bathing and sleeping. And psychologically, my confidence had been affected. I wanted to return home but, living alone, I knew I would need help and assistance.
I was hyper-aware of the dramatic consequences that had resulted from the most trivial stumble. I now viewed every flight of stairs, each gutter and broken footpath and all jostling crowds with trepidation. As the time came to move home, I realised I would require nursing support, physiotherapy as well as the basic items of hospital equipment that made bathing, sitting and sleeping easier.
I was able to use my private health fund, Medibank to help with care at home. Medibank, like some public providers, has developed approaches to help people like me who do not need full-time hospital care, but consistent care either at home, or in “half-way” accommodation. This was what I needed to help restore the sense of agency and confidence that had been shaken by the accident. When I returned home, I was visited regularly for weeks by nurse Alex and physio Arthur. These visits were not only clinical but also became more personal. Simple things like receiving a shave to make the brace more bearable had a positive impact on my mental health. Sleeping in your own bed, preparing your own food and seeing family and friends without the restrictions of hospital life helped recovery and healing.
About six weeks ago, and four months after the accident, the healing had progressed well enough to dispense with the 24/7 neck brace. But long months of immobility had atrophied my neck and shoulder muscles. I no longer required home nursing but now needed consistent physiotherapy to reactivate these muscles and regain flexibility.
This year, I tested the Medicare public health system. I have been an inpatient in three hospitals in two countries. I received expert diagnosis and assessments from highly qualified and experienced specialists, and compassionate care and treatment from nurses, psychologists, nutritionists, physiotherapists and support staff at all levels. I have undergone perhaps 10 CAT scans both as an in-patient and out-patient. I moved from hospital to home with no fuss, but with continued care delivered by Medibank. During this process, I received care from some of the best professionals in the world, and yet, one of the most important elements of my recovery didn’t happen inside a hospital room: it happened in my own home.
Financially, all the major expenses were covered through the Medicare reciprocal agreement in New Zealand and Medicare and my health insurer in Australia. The only significant extra outlays were the costs of the nurse escort from Christchurch to Sydney and the gap payments from out-patient CAT scans which added up to perhaps $1500. I also pay a modest gap payment for the regular home-based physiotherapist visits. That’s it.
The promise of Medicare is the provision of excellent care based on clinical need not capacity to pay. In my case, a complex web of diagnosis, care, treatment and support was provided to me by skilled and compassionate clinicians and professionals. They, and my dear friends, helped to get me literally back on my feet. At every critical point, they took the right decisions that saved my life and then put me on the road to recovery.
For me, Medicare’s promises were met. Four decades ago, when Medicare was introduced, with the same injuries my stay in hospital would have been much longer, the diagnostic tools much less accurate and the path to recovery more uncertain than in 2025. Australia does tremendously well to provide high standards of hospital care through the public hospital system complemented by private hospitals underwritten by well-regulated private health funds and with medical services provided by a single-payer national insurer, Medicare. But over the four decades of Medicare, the Australian population has almost doubled while living longer and growing older.
Medical technology and therapies have improved remarkably while becoming more expensive. The way we deliver healthcare has changed. Technology has transformed our options for remote care, and patient expectations have fundamentally shifted. Quite properly, Australians demand higher standards of service and accessibility in every sector including provision of medical and hospital services.
The foundational principles of Medicare can only be maintained if rapid innovation and productivity gains are made across the system. Technological, social, demographic and financial changes are rapidly undermining the old-model of hospital-centric care. Many conditions, including mine, once required lengthy hospital stays and then travelling to hospital outpatient clinics.
“Hospital in the home” services and/or care in intermediate accommodation is demonstrably much better for patients, providers and the overall health budget. But these services are still not offered routinely as part of a continuum of care.
As someone who has spent over four decades in health policy, working to reform and improve our system, I can tell you my experience has reinforced a point I’ve been making for years: our health system is due for reform and a health transition is on the horizon. It’s time to rethink how we deliver care, particularly when it comes to the critical need for services outside the traditional walls of hospitals. The at-home care provided by my health insurer should be rolled out across the system,
The financial and human resources freed up by more productive and beneficial care can then be re-allocated to dealing with more chronic, complex conditions in better-equipped hospitals.
The success of Medibank’s at home care shows this is an achievable reform that should be worked up by governments, private insurers and hospital and health professionals and especially doctors. Of course, I am just one of the many people treated this year. Doubtless, different circumstances can bring about other and perhaps less satisfactory outcomes than mine.
But when I needed excellent care and treatment, I received it.
For that, I am tremendously grateful.
Bill Bowtell AO is one of Australia’s leading health policy strategists, was a senior adviser to former prime minister Paul Keating, and helped to deliver Australia’s groundbreaking HIV/AIDS response.