The scale of the challenges facing the Australian health “system” right now is illustrated by the numerous reviews looking to reform systemic frailties.
There are quote marks around the word “system” because, as has been pointed out before, Australia’s national approach to the care of the sick and promotion of health and wellbeing can hardly be called a system.
The worrying gaps and dysfunction in our $140 billion a year health arrangements are graphically highlighted by the fact that there are SIX national reviews proposed or in train examining pivotal aspects of health care and funding in Australia.
Let’s be clear, we are not talking about abstract matters of high medical science here, but rather problems that impact most often on the sickest in our community, who for reasons of money or location struggle to get the care that is often within easy reach of others in Australia.
The areas under scrutiny range across the spectrum of health services.
The government is soon to give its response to the National Mental Health Commission’s report, which called for a substantial revamp and funding redirection to improve our services for those living with mental illness.
Two expert groups are reviewing fundamental elements of Medicare – primary care and the Medicare Benefits Schedule – to reform the focus and funding of our national health services to reflect the demands of chronic disease and changes in medical treatment and technology.
The multi-billion dollar pharmacy agreement, which finances and protects retail pharmacists from competition is about to be reviewed.
Private health insurance, costing the taxpayer $6 billion a year but creating growing angst for consumers because of rising premiums and often shrinking cover, is to be examined in a quick review to be announced very soon.
Finally and, fundamentally – although few Australians have noticed – is the federation white paper process, which is exploring how all Australian governments can better structure administration and funding, most importantly in health, to unify and harness the huge effort and costs that are sunk into health services and hospitals.
It is a central failing of the Australian arrangements that for constitutional and historical reasons we have health arrangements that, despite the impressive qualities of its workforce and institutions, often fail to meet their potential and face growing cost pressures, when better options are available through better organisation. We simply must strive for a better integrated system if we are to future-proof it. How we structure and organise the system in a way that doesn’t perpetuate past approaches is key. We need different, not necessarily more.
An effective national health system should surely be founded on central principles of quality, safety and equity of access.
A striking example of where we seem to be failing in terms of these principles is primary care, in services delivered outside hospital, particularly for the chronically ill. Because of outmoded elements of Medicare, the state-federal funding divisions and health workforce silos, many Australians with chronic illness fail to receive the kind of coordinated care that would improve and lengthen their lives.
Mental health patients miss out on routine but effective care because of cost and other barriers to access to appropriate care. The uninsured wait months and years for joint surgery that would end their pain and restore mobility.
The Consumers Health Forum has welcomed the vigour the Health Minister Sussan Ley has shown since taking on the job less than a year ago in being prepared to put health care delivery under scrutiny.
The reviews, largely initiated under her ministry, are into on-the-ground issues that the previous Labor government failed to grapple with despite its much-vaunted Health and Hospitals Reform Commission.
All of the reviews in their own context are needed and welcome. Our concern is that such is their individual importance and the concentrated focus taken for each that the result could well be, to use a sports analogy, a team of champions rather than a champion team. We can’t risk creating a system that is more fragmented than our current one.
It is imperative that we have integrated policy and a coherent set of arrangements across our public-private health system. If we don’t, the risk is unexpected casualties. If we accept that a fundamental aim of a national health system is to ensure quality care for all Australians, what would changes to health insurance, say an expansion into primary care, mean for the majority of Australians who do not have insurance?
The Consumers Health Forum has long advocated a Productivity Commission inquiry into health insurance because its rationale is becoming increasingly uncertain given the swelling cost to taxpayers and members and the failure to make significant inroads into public hospital waiting lists.
That is but one example of the unexpected side effects of a patchwork approach to health. We need to see a clearer picture from government of how it plans to bring together the great and varied strengths to create a true national health system. Prime Minister Turnbull has pledged that it is an exciting time to be an Australian and, as a nation, we have every reason to be innovators. Rejuvenating health and the way we look after the health of the community must be key to that agenda. It is time for leading policy and innovation in health.
Leanne Wells is CEO of the Consumers Health Forum of Australia