Healthy challenges await new minister
With his new Health Minister, the Prime Minister is signalling a refreshed approach to health policy.
It is encouraging that Malcolm Turnbull has asserted a new focus on the previously abandoned area of preventive health, promising to give people “the right tools and information to live active and healthy lives”.
More boldly, the Health Minister, Greg Hunt, has set himself the ambitious long term health strategy of seeking to build Australia’s health system to be “the best in the world”, as reported in The Australian.
Making it work however we believe will challenge the Government to consider options that have been previously been ruled out: like new revenue sources and rethinking current “savings” measures.
In his ambition to make our health system world’s best, Mr Hunt has identified four goals: the need to strengthen Medicare, support hospitals, facilitate world class medical research and encourage people to take better care.
These are clear aims that few could disagree with. However there are intimidating hurdles.
The unresolved dilemmas overshadowing the national health system range across the spectrum: the multi-billion dollar budget overhang for public hospitals, doctors rebellious over the Medicare benefits freeze, primary and regional health arrangements yet to be fully bedded down, and deep concerns about the adequacy of mental health services.
And that’s only the beginning of his work sheet. The absence of a national preventive health strategy to respond to the problem of obesity, increasingly problem-prone private health insurance, and the proposed reforms of pharmacy and the Medicare benefits system in the face of fiercely protective professional lobbies also await his attention.
So many of these issues revolve around the eternal question of how to ensure our national health system can deliver reasonable health care to all at a price the nation can afford. We must proceed with attempts to make the health system more effective and effficient to ensure it even better meets consumer expectations of a modern health system.
The success of Mr Hunt’s aspirations almost certainly depends on having fresh money to kick start reforms. The “Mediscare” phenomenon worked because so many budget health measures were seen as weakening Medicare.
An example of an alternative path would be the Federal Government’s planned trials of the Health Care Homes concept which aims to usher in a new era of consumer-focused integrated care in the community, particularly for those with chronic and complex illness. This type of care arrangement should, over time, be extended to families with children. The benefit, apart from happier and healthier people, would be the ultimate reduction in costly hospitalisations for avoidable complications. But to achieve this would require a range of care options, led by the GP, to include integrated care delivered by a team providing services not currently covered by Medicare. Ideally, it would also include ‘social prescribing’: coordinating health care with some of the community services such as support to find work and housing that, left unaddressed, only result in health setbacks no matter what the quality of medical care.
The vision for Health Care Homes is entirely feasible and indeed necessary if we are to adopt the benefits of advances in health care knowledge and technology like eHealth to bring health care up to 21st century potential. However the presently proposed funding falls far short of what is required for an effective outcome.
The recent speculation of a possible increase in the Medicare levy to infuse the health system with fresh funding opens an option that could give the Government a reinvigorated direction, as does new commentary from the OECD and others that some health spending makes little or no contribution to improving health: there’s scope to limit ineffective spending and waste and redirect it to higher value health care.
The Australian community puts health at the top of its concerns and previous experience indicates that a rise in the Medicare levy for clear and important purposes is likely to be supported by most Australians.
A levy hike that is seen as merely boosting doctors’ incomes - even though GPs have a strong case for higher Medicare payment - would not do.
We believe that the freeze in Medicare benefits for GP services should be lifted. But that should be part of a much broader re-development of the health system to make it more focused on care outcomes and more responsive to consumer needs such as envisaged with Health Care Homes.
Chronic conditions like diabetes, mental illness and obesity, so common today require a revamp of Medicare to finance and reward longer term coordinated approaches, not the largely one-off episodes of care common when Medicare began in 1984.
If we are to have a health system reflecting the characteristics we have the research, workforce, infrastructure and know-how to deliver, GPs would lead a team approach integrating pharmacy, allied health providers like physiotherapists and support staff to help patients get the right services in a system where funding provides incentives not only for quality care but also targeting wellbeing goals like better diet.
The recent creation of the Primary Health Networks provides further great potential for a reinvigorated Medicare as these will be able to supplement health care with locally tailored services.
Expenditure that helps improve the nation’s health is an investment in our most important asset. An increase in the Medicare levy may be speculation, but it could well be considered such an investment particularly if balanced by a redirection of wasteful expenditure to higher value care.