THE healthcare system is at a crossroads. The system we set up in July 1975 when Medibank officially began almost 40 years ago no longer meets our needs. But when we consider the population in 1975 was 13.9 million as opposed to the 23.7 million we are today then this should be no surprise.
Treasury’s first Intergenerational Report in 2007 forecast government expenditure on health was projected to increase as a proportion of gross domestic product from 3.5 per cent in 2006-07 to 7.3 per cent in 2046-47, with about a quarter of these increased costs coming from an ageing population.
Treasury’s 2010 Intergenerational Report identifies several drivers of the expected rise to extend beyond just an ageing population to include population growth, demographic pressures, demand for higher standards of care, as well as rapid technological innovation.
Medical knowledge, technologies and treatments have not remained static; they have changed and evolved and hopefully will continue to evolve into the future for our collective benefit.
All of this creates stresses that Medicare’s structure cannot handle.
Last month, Health Minister Sussan Ley pointed out the inconvenient truth about Medicare: “It’s not sustainable now.
“The Medicare levy raises $10 billion approximately at the moment and the cost of Medicare is $20bn. So the Medicare levy is hopelessly inadequate in funding Medicare, but the scary thing is in 10 years’ time the cost of Medicare will be $34bn and, while the Medicare levy will be a bit more, it will be nowhere near that figure.
“So everyone recognises we need to make Medicare sustainable and we can’t have it collapse under its own weight.”
Structural reform of Medicare is the one of our greatest public policy challenges. Failure to address it will fundamentally change our quality of life for the worse.
Good policy does not happen in a vacuum; the highly regrettable combative nature of our political environment can make the achievement of this goal seemingly impossible.
Much of the discussion has focused on the concept of a co-payment and the need to send a price signal to the market. I am uncomfortable with the notion people should be seen as a cost unit. But the reality is doctors are also businesspeople and their businesses need to be viable to provide a service.
I feel a more appropriate lens to view the provision of health services should be one of value and quality, with price to be determined by the ability to pay.
Any consideration of a co-payment can’t be hijacked again by low-grade political misinformation and ignorance.
In this regard, the high standard of healthcare provided in Scandinavian countries is often cited as an aspirational target. What are not mentioned in this consideration are these facts:
●In Denmark, cost-sharing applies to dental care for those over the age of 18, prescriptions and corrective lenses, and patients with out-of-pocket costs for prescription are reimbursed based on their income levels.
●In Norway, GP and specialist visits, including outpatient hospital care and same-day surgery, require patient co-payment, as do physiotherapy and prescription drugs. A safety net applies so that once an annual threshold is reached, further out-of-pocket expenses are waived. Children and certain other groups are exempt from co-payments.
●In Sweden, patient co-payments apply to most healthcare services with the amount determined by each municipal council.
In most council areas, people under 20 are exempt from user charges and older and disabled patients are charged a different level of co-payment.
There is also a national ceiling for out-of-pocket payments that ensures individuals will never pay more than an annual threshold of about $169 for healthcare visits. There is a separate safety net for pharmaceuticals.
●In Iceland, co-payments apply to most medical services with the amount varying depending on patient categories, which are income and age related.
Doctors from my electorate who have participated in Ley’s consultation process have argued a co-payment is necessary to reduce the rate of unnecessary consultations and have proposed the concept of a self-determined co-payment for bulk-billed services.
Under this concept, individual general practitioners would have discretion to determine the level of the co-payment to be charged. GPs would achieve a level of control over their own fee structure and also would have the ability to reduce or waive the co-payment in individual cases of real hardship or special needs.
This is one option to be considered in the primary care space, which is where most Australians experience healthcare in the first instance.
But I stress that this is just the beginning of the dialogue we have to have.
We need to determine how to best care for chronic disease sufferers; how to get them out of doctors’ surgeries and the prohibitively expensive hospital system and into home care arrangements that better meet their needs.
We also need to work out how we are going to structure the health budget to properly cater for the linkages between primary healthcare, the delivery of secondary healthcare through specialists and how we develop skills for the future through our medical teaching facilities in the tertiary sector.
My challenge to my parliamentary colleagues of all parties is this: put aside your petty political divisions and support the Medicare consultation process Ley is undertaking around the country.
If ever there was a public policy issue demanding bipartisan support then this is it.
Teresa Gambaro is the federal member for Brisbane.
Source: The Australian