In­ter-gov­ern­ment bick­er­ing over health care must stop

The Weekend Australian - Travel - - Health - MITCH MESSER

THEY may dis­agree about ev­ery­thing from choice of foot­ball code to whether meat pies come with tomato sauce or pea soup, but one thing the states and ter­ri­to­ries al­ways agree on is that the Com­mon­wealth should pay more for health care.

Last week­end the state and ter­ri­tory gov­ern­ments jointly re­leased a re­port ar­gu­ing that they had been short-changed to the tune of $1.1 bil­lion in pub­lic hospi­tal fund­ing.

Con­sumers have good rea­son to be cyn­i­cal about this move. While many would sup­port ad­di­tional fund­ing for the pub­lic health sys­tem, the end­less bick­er­ing be­tween gov­ern­ments about who pays the bills for health care is be­com­ing more than a lit­tle tire­some.

What politi­cians seem to for­get is that re­gard­less of who signs the health care cheques, the money to pay the bills is com­ing out of con­sumers’ pock­ets. If gov­ern­ments were se­ri­ous about im­prov­ing the health sys­tem, they would stop ar­gu­ing about fund­ing re­spon­si­bil­i­ties and start talk­ing to con­sumers about whether they feel they are get­ting good value for their tax dol­lars.

From our wide­spread con­sul­ta­tions on the per­for­mance of the health sys­tem, the Con­sumers’ Health Fo­rum of Aus­tralia (CHF) has found that many con­sumers are not sat­is­fied with the level of care they re­ceive.

For ex­am­ple, we of­ten hear from peo­ple who are di­ag­nosed with a spe­cific ill­ness or con­di­tion and who find them­selves on their own, try­ing to ne­go­ti­ate through an of­ten com­plex health care sys­tem with­out be­ing given ad­e­quate in­for­ma­tion about en­ti­tle­ments, or any sup­port to help them ac­cess the best pos­si­ble care for their con­di­tion.

This is par­tic­u­larly true for peo­ple with chronic and com­plex con­di­tions who of­ten re­quire on­go­ing treat­ment from a range of dif­fer­ent providers and in a range of dif­fer­ent set­tings. This group of health­care con­sumers fre­quently re­ports prob­lems such as a lack of co-or­di­na­tion be­tween health­care providers and health ser­vices, so that they are forced to tell their story over and over again each time they re­quire health care.

Some­times tests have to be du­pli­cated be­cause data hasn’t been shared be­tween health­care providers. Th­ese can be in­va­sive, in­con­ve­nient for con­sumers and an un­nec­es­sary use of re­sources.

Con­sumers with more com­plex needs can also have dif­fi­culty find­ing a health pro­fes­sional who un­der­stands their con­di­tion, par­tic­u­larly if they re­quire care af­ter hours or in an emer­gency. Of­ten they feel they know more about their con­di­tion than the ju­nior doc­tor in a hospi­tal emer­gency de­part­ment.

An­other com­mon prob­lem is that con­sulta- tion times are of­ten not long enough for con­sumers to pro­vide all the rel­e­vant in­for­ma­tion about a com­plex con­di­tion. Some health prob­lems sim­ply can­not be dealt with in a sixminute con­sul­ta­tion.

In gen­eral, peo­ple with chronic ill­nesses find that there is no one in the health sys­tem who is re­spon­si­ble for over­see­ing their care, who man­ages the dif­fer­ent ser­vices re­quired and who un­der­stand the to­tal needs of a per­son with a com­plex con­di­tion.

The Con­sumers’ Health Fo­rum ac­knowl­edges that there have been some at­tempts to help the health sys­tem pro­vide bet­ter care to peo­ple with th­ese con­di­tions. Re­cent gov­ern­ment ini­tia­tives in­clude the co-or­di­nated care tri­als, the en­hanced pri­mary care Medi­care item num­bers and pro­grams that sup­port self­man­age­ment for chronic con­di­tions.

How­ever, th­ese have had only lim­ited suc­cess, per­haps be­cause they are of­ten not based on an equal part­ner­ship with con­sumers. From con­sumers’ perspectives, they of­ten seem to be more about meet­ing the needs of health­care providers than about im­prov­ing qual­ity of care. Per­haps it is sim­ply eas­ier for gov­ern­ments to ar­gue with doc­tors and hos­pi­tals — and among them­selves — about health fund­ing, than to make the changes re­quired to de­liver a truly con­sumer-fo­cused health sys­tem.

The end re­sult of this, how­ever, is an in­creased cyn­i­cism among con­sumers about gov­ern­ments’ real com­mit­ment to im­prov­ing health care. New ini­tia­tives come and go, but the in-fight­ing be­tween gov­ern­ments over health fund­ing re­mains.

Real and last­ing im­prove­ments to our health sys­tem will only hap­pen if gov­ern­ments make a gen­uine at­tempt to end their bick­er­ing over health fund­ing and lis­ten to the peo­ple who use, and ul­ti­mately pay for, all health­care ser­vices. Mitch Messer is chair­man of the Con­sumers’ Health Fo­rum of Aus­tralia

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