Keeping the health system universal without blowing the budget
Few would argue that Australia’s health system faces extraordinary cost challenges if we are to maintain any pretence of a universal health scheme.
What may surprise many however is the wide range of apparently feasible options available to make health care both better and more cost effective in Australia.
That is what the Consumers Health Forum journal, Health Voices, found when it asked 20-odd experts to explain how we could get a “better bang for the buck” out of our $140 billion a year health expenditure.
Among the most common solutions proposed by the experts were achievable ideas to enhance access to primary care in the community thus reducing costly hospital admissions, and to make the health system much more transparent and performance-driven.
Most are rational measures, making the best of modern practice and technology. Most need not be financially extravagant and do not offend ideologies on either side of politics. However they would require significant changes in behaviour and culture of health organisations and professionals.
As veteran health economist, Paul Gross writes, ignoring the need for substantial changes would add to the “epidemic of mural dyslexia, the unwillingness of politicians to see the writing on the wall when we have an ageing society with unfunded care needs”.
CHF believes that the nub of the health system dilemma is the tension between equity and cost of health care.
The Health Minister, Peter Dutton, points to this issue, in his article for Health Voices. He suggests that expanding health insurance cover may offer a solution. We at CHF believe that while this may improve health outcomes for the insured, it would further inflate premiums, and result in the uninsured getting second class access to GPs, at a time when a two-tiered system is emerging between the haves and have-nots in health care.
The invaluable step Mr Dutton has taken is to encourage a national debate which raises the issue of how Australia ensures a vigorous health system while maintaining equity of access regardless of income.
This is a dilemma that too few politicians are prepared to canvas. Mr Dutton writes that Australians know all is not well when they can’t book a timely visit to the GP, when they get a bill for elective surgery or when there are stories of “hidden waiting lists and inequities which shouldn’t be tolerated”.
Medicare he likens to the Holden Kingswood, popular in the 1970s but now out of date. The public hospital system is “shackled by archaic practices” resulting in tens of thousands of patients on waiting lists.
The greatest opportunity, he suggests is presented by the potential of primary care to ease the burden on hospitals.
Mr Dutton suggests that if health funds can expand their reach into GP-led primary care, particularly of chronic conditions, this had the potential to “save a lot in human and financial terms”.
That may be true. But what about the majority of Australians without health insurance, who may well find themselves getting second best preference in primary care?
Emeritus Professor of Public Health, Stephen Leeder, says in his article that there is no reason for government to back away from universal health care. It is more a matter of getting the system right and managing it well.
He cites findings from an international survey by McKinsey and Company which underlines the benefits of accountability and rewards for effective care; of catching up on international trends in ehealth information management in which Australia lags by 20 years; making the patient the centre of “EVERYTHING” in health care; and more comprehensive planning.
As CHF’s own policy specialists, Deborah Smith and Sarah Spiller, have found through CHF’s “Real People, Real Data” project, a fundamental benefit flows from ensuring the consumer experience is central to health care. “The answer is often as much about self-care as medical treatment,” they say.
Health economist Jennifer Doggett identified five steps Australia could take to improve the system, before reaching into the pockets of vulnerable people. A focus on best value activities like preventive health services rather than on an estimated 150 low value medical and surgical interventions; steps to counter federal-state dysfunction by a health consumers charter setting national uniform care standards; fostering more effective coordinated care for chronic conditions; and redirecting the health insurance rebate to support patient choice of public or private systems providing best value care.
The great goal of health reform has been the establishment of pooled federal-state funding, something Tony Abbott pondered when he was Health Minister.
But as Christine Bennett, the former chair of the National Hospitals and Health Reform Commission, writes, we no longer have the time to wait for the single funder dream. “What we can focus on right now within current funding and delivery responsibilities is taking effective local action and implementing system-wide catalysts to support integrated care. State health departments, the Commonwealth, private health insurers, local councils and local communities all have roles to play,” she says.
In all these options, we simply ask that consumers, as the reason which the system exists, should be the beneficiaries of health system change, not poorer because of it.