KEY POINTS:
Early last month, 30-year-old Allan Osterberg arrived at the emergency ward of Canberra Hospital, ill enough for staff to class him as a category three on the triage system that ranks the priority given to patients.
That meant he should have been seen within 30 minutes. Instead, he waited.
More than four hours after he arrived, staff found him slumped in a chair, dead from cardiac arrest.
In Sydney a month earlier, following a previous miscarriage and worried by cramps 14 weeks into a new pregnancy, 32-year-old Jana Horska arrived at Royal North Shore Hospital's emergency ward. Staff confirmed her worst fears: she was miscarrying again.
Despite efforts by husband Mark Dreyer to get help, Horska was left waiting for two hours. She began bleeding, went into a toilet and collapsed. Dreyer heard screams, rushed in and found her covered in blood, holding a live foetus between her legs.
Investigations by the Sydney Morning Herald uncovered other disturbing cases. Jenny Langmaid, after two previous miscarriages and feeling ill - also 14 weeks into another pregnancy - arrived at Royal North Shore and told staff she feared she was in labour.
Two-and-a-half hours later, and in great pain, she went into the toilet: a baby dropped into the bowl.
Another woman bleeding from a miscarriage was "lost" at the same hospital overnight and spent more than nine hours unattended in a consulting room. A 91-year-old woman was left for a night and the following day in a supply room.
Australians were shocked by these cases. But they were not surprised. The nation's public hospital system has been in steep and disturbing decline for years, marked by bed shortages and huge waiting lists.
General practice is also under pressure and public dental care - in some areas the only option - has waiting lists that stretch into months. In rural areas, hospitals are being closed, doctors are scarcer than rainclouds - even a A$500,000 ($602,000) sweetener could not buy the small New South Wales country town of Temora a GP - and specialist care is frequently not available at all.
For Aborigines, the position is worse again.
An Australian Medical Association report card on the state of indigenous health released in May said that, despite new programmes, there were still too many barriers preventing Aboriginal patients getting access to needed care.
With the life span for indigenous Australians 17 years shorter than the rest of the population, the association estimates that at least A$460 million a year in new funding is needed to make any real inroads. For good reason, Australia's politicians are now putting health at the top of their agendas.
Across the nation, hospitals and the health system are among the highest priorities for voters set to go to the polls on November 24 to elect a new federal government.
It makes no difference that the primary responsibility lies with state governments. The lines blur in the minds of voters disturbed by a system that despite many real qualities and achievements is scarred by deep and sometimes fatal flaws.
As the election campaign opened, the Doctors' Reform Society demanded real policies. Society president Tim Woodruff asked: "In the face of overwhelming evidence that our public hospitals and public health system are under enormous strain, which politicians are prepared to commit to (its) immediate and long-term survival and strengthening?"
There have been real achievements. Since Prime Minister John Howard won power in 1996, health spending has increased from 15 per cent of the federal budget to about 22 per cent, with A$52 billion allocated for the present financial year.
Spending on the Medicare universal health care system has almost doubled in real terms to A$12.5 billion and bulk billing rates for doctors - where fees are charged directly to the Government - are at record levels. Spending on subsidised prescription drugs has more than doubled to A$7.5 billion and Canberra is giving the states A$42 billion to help run public hospitals.
But the pressures are increasing.
The Australian Medical Association recently released its latest annual report card on public hospitals. It made disturbing reading.
In the past 20 years, public hospital capacity has been slashed by 60 per cent, the chances of failures in the system are too high and hospitals are running too much at unsafe capacity levels - especially at teaching hospitals.
The impact on patients is alarming: fewer than two-thirds of patients at emergency wards are seen within clinically appropriate times and more than 500,000 people arriving with symptoms such as moderately severe blood loss, persistent vomiting and dehydration are not seen within the benchmark period of 30 minutes.
Because there are not enough beds and too many are filled by patients no longer needing acute treatment but still requiring care - especially the aged - emergency departments can barely cope.
Elsewhere, the association says there has been a marked deterioration in the proportion of patients being admitted for elective surgery within the medically recommended times and waiting lists have blown out across the country.
Further evidence of a mounting crisis has come from Queensland, most dramatically in the case of Jayant Patel, the fugitive Indian surgeon known as "Dr Death" who fled to the United States to escape charges following investigations that showed he caused 13 patients to die at Bundaberg Base Hospital.
Patel's case not only highlighted major administrative and bureaucratic flaws in the state's health system - creating a political nightmare for the ruling Labor Government - but also drew attention to a shortage of doctors that needs to be filled by recruiting foreigners.
A Government review of Queensland's outpatient services reported more problems: as at the beginning of March this year, 143,000 people were waiting for appointments, with even some urgent cases waiting for more than 12 months.
Family doctors, who 90 per cent of Australians visit at least once a year, are also an endangered species.
The Australian Medical Journal last year reported that fewer medical graduates are choosing general practice, deterred by high workloads, low morale, a heavy administrative burden and poor job satisfaction.
Politically, the escape route has been for federal and state governments to blame each other.
This is the tack the Government is taking as it struggles to close the gap with the Labor Opposition ahead of this month's federal election.
Both sides have heeded the message that, blame aside, voters want action. In one day alone, on Wednesday, they pledged almost A$1 billion to fix the system, promising federal intervention in public hospitals if the states could not do the job.
To mixed receptions, Labor leader Kevin Rudd promised A$600 million to reduce elective surgery waiting lists and Howard allocated A$310 million for doctor training places and to provide home nursing care for the aged.
The Government, which will announce a new package next week to address waiting lists and other issues, wants to place hospitals in the charge of federally-responsible local boards.
Rudd has a A$2 billion national health and hospital reform plan which, if the states do not implement by mid-2009, Canberra will impose by assuming financial control of the nation's 750 public hospitals.
For both sides, health has become critical.
