Preventive measures the most effective health policy prescription
This article was first published in The Australian
Health is once again a target for billions of taxpayer dollars in election promises that may soothe but never heal community concerns.
There has been no shortage of diagnoses about what ails the health system. A feature of Australia’s health policy in the past decade has been the preponderance of probes into various elements of the health sector, ranging from system-wide inquiries to more focused reviews of troubled areas.
The Coalition government, since coming to power in 2013, has instituted a clutch of reviews into key problem zones: primary care for the chronically ill, mental health, private health insurance, out-of-pocket medical costs, regulation and remuneration of pharmacies, and the efficacy of high-cost Medicare benefits.
These reviews produced various ideas for change and improvement, but community unease about health still creates a spike in public opinion surveys.
There were two recurring concerns raised by respondents to a recent survey conducted by the Consumers Health Forum. The issues were cost and uncertainty. These are worry points often reflected in the focus of the health policies announced so far in this federal election campaign.
The out-of-pocket costs dilemma confronting so many patients in Australia also is often connected to a widespread sense of uncertainty about healthcare and its co-ordination — what care is needed, its cost and where to go for appropriate treatment.
Our survey found most people were satisfied with the quality of the healthcare they received. However, a third encountered difficulties at every stage of the healthcare process, such as finding the right place to get care, deciding which provider to see and getting to see the provider they needed.
The unease about care costs and uncertain access to co-ordinated care have prompted a variety of responses from the political parties.
Labor has proposed a plan to reduce out-of-pocket costs for cancer patients; the Coalition is pledging support for streamlined access to integrated care for the over-70s and a new website detailing medical specialists’ fees. And both sides promise more hospital funding and a continuing stream of new drugs on the Pharmaceutical Benefits Scheme.
But there remains the reality that we are getting piecemeal measures when what is needed is a holistic approach with overarching strategies reflecting all of the modern world’s knowledge about the causes of ill health and our capacity to avoid ill health.
We are proposing that the next federal government give priority to three areas: childhood obesity, public dental services and primary healthcare. We don’t need more reviews. Experience has shown stopgap health policies won’t pay in the long run. The evidence here and internationally tells us that the best overall returns for the health dollar will come from nationally co-ordinated preventive health measures to counter modern malaises of obesity and chronic illness.
Closely linked to the prevention drive should be better resourced primary health services — GP-led team care for the growing number of chronically ill and older patients. People want affordable, convenient and reliable care close to home,
The political default on health is to offer more and bigger hospitals. We need to rebalance the investment to give more focus on comprehensive care in the community that reduces our dependence on hospitals.
Obesity is a dominant factor in chronic illness yet as a nation we have no coherent, effective strategy to counter poor diet and promotion to children of unhealthy food and drink, and to take other more practical measures, such as overcoming urban planning and transport obstacles to routine activities such as walking.
Modern economies and digital technology have brought new levels of consumer control and understanding to most corners of society. Yet health, despite the expertise of its practitioners and reliance on precision record-keeping elsewhere in healthcare, lags behind 21st-century potential when it comes to communications with patients. Instead, we as a wealthy country have hundreds of thousands of people each year putting off having scripts filled, seeing a specialist or living with the misery of toothache because they can’t afford a dentist.
Australia’s health system remains less efficient than it should be and federal-state divisions in health funding and the resistance of practitioners to change, or lack of support for practitioners to change, are significant impediments. We have seen in recent years welcome strides towards a more transparent and accountable health system. Consumers must be empowered with more government support for the development of consumer leadership and patient-centred care to improve not only health outcomes but also the working experience of clinicians.
Transforming services by encouraging consumer-influenced health services and patient engagement in healthcare can bring long-term benefits to Australia’s physical and fiscal health.