Under-spending on health is a false economy

THEelection campaign will soon turn at last to the topic likely to determine who wins government — health and hospitals.

Public polling, backed by internal party research, shows the extent of public concern about public hospitals, which suffered under the previous Labor-Green government and have been in even steeper decline under the Liberals.

But the debate is likely to focus on hospitals which, crucial as they are, form only part of the health system. And the rest of the system is deteriorating just as much.

The many services outside hospitals — general practice, home nursing, alcohol and drug services, mental health — are all under siege from the neglect and underfunding of state and federal governments.

These are broadly known as primary care and are designed to keep people out of hospital.

Hospital admission is a much more expensive option, so starving a cheaper alternative makes no sense at all.

Year after year, the Federal Government has frozen Medicare payments to GPs, forcing patients to pick up the tab. Australian Bureau of Statistics surveys show an alarming number of people avoid going to the doctor because of cost.

The damage caused by State Government neglect is as serious but, unlike the Medicare freeze, has gone largely unnoticed by journalists and the voting public. But it’s the worst in the nation and the consequences are profound.

The Australian Institute of Health and Welfare shows the Tasmanian Government spends $115 per head of population less than other states on out-of-hospital health services. That’s $60 million.

But that doesn’t include the money the Government gets in extra GST in recognition of our greater needs for community health services. That’s worth another $25 million a year, and it goes nowhere near health. Instead, the Government takes that money in its quest for a budget surplus.

State Government underfunding of primary health adds up to about $85 million a year. We would need to spend that much more just to give Tasmanians the care other Australians take for granted.

We do not have individual figures for each element, but what we have indicates the size and scale of the problem.

It is perhaps most stark in our underfunding of prevention services — the many measures, including campaigns, to prevent people becoming ill in the first place. For every dollar other states spend on this area per head of population, we spend just 58 cents.

Our older, sicker and poorer population relies more than other Australians on public dentistry, which isn’t covered by Medicare. Again, Tasmania has the worst funding record when it ought to have one of the best. We would need to spend 25 per cent more than we do just to catch up to the rest of the country.

And it should come as no surprise that ambulance services struggle to keep up with demand. The State Government would need to spend a third more to give Tasmanians a national-standard service.

Primary health care reaches into the lives of almost everyone. And the services that are being short-changed — or that aren’t there at all — affect the whole community.

There are the residential alcohol and detoxification centres we don’t have, the mother-and-baby services we don’t have. Specialist community clinics, particularly in high-need areas. Anti-smoking campaigns so underfunded they are unlikely to work. Nutritional programs to help reduce obesity. Mental health organisations overwhelmed with the task. The list goes on.

Right now the Government is content, to the extent they consider it at all, to leave it all to hard-pressed GPs who do not have the time or resources to do much more.

Bridging the funding shortfall is only the start. Primary care is complex, so any plan to fix it needs policy thinking of the highest order. Good luck with that. We are about to have an election but neither party has a coherent policy. Martyn Goddard is an independent health policy analyst based in Hobart.