Can this elec­tion bring af­ford­able, eq­ui­table, qual­ity ser­vices?

The Weekend Australian - Travel - - Health - FIONA ARM­STRONG

DE­SPITE our rep­u­ta­tion as the dri­est con­ti­nent on earth, Aus­tralians are shocked to find our wa­ter sup­ply sud­denly ten­u­ous and our food se­cu­rity un­der threat. But how many are aware our health care sys­tem is also in grave dan­ger?

Cur­rent po­lit­i­cal de­bates around cli­mate change and the drought have shifted the eyes of the pub­lic from mount­ing pres­sure in the health sec­tor for re­form. De­spite the shock an­nounce­ment of fed­eral gov­ern­ment ini­tia­tives in the North­ern Ter­ri­tory, the pres­sure in the health sec­tor for change to en­sure eq­ui­table ac­cess to ser­vices con­tin­ues to build.

Con­cerns about the sus­tain­abil­ity of our en­vi­ron­ment ex­tend also to the sus­tain­abil­ity of re­sources in the health sec­tor, as our age­ing pop­u­la­tion puts pres­sure on a di­min­ish­ing and age­ing work­force. Bal­loon­ing costs as­so­ci­ated with ris­ing de­mand, as well as un­prece­dented use of tech­nol­ogy, are plac­ing huge pres­sure on health care bud­gets, while work­force short­ages are cre­at­ing un­sus­tain­able work­loads for those de­liv­er­ing ser­vices.

Given the quan­tum of funds in­volved (around $80 bil­lion an­nu­ally) and the in­escap- able pres­sures on the health bud­get, it is vi­tal to en­sure fund­ing is de­liv­ered by the most ef­fec­tive, cost ef­fec­tive, and eq­ui­table means.

How­ever, there is sub­stan­tial ev­i­dence to sug­gest this is not oc­cur­ring, with con­ser­va­tive es­ti­mates of $2 bil­lion be­ing wasted an­nu­ally (there are higher es­ti­mates kick­ing around), at­trib­ut­able to the in­ef­fi­cient di­vi­sion of re­spon­si­bil­i­ties for health fund­ing be­tween the fed­eral and state gov­ern­ments alone.

The cur­rent di­vi­sion of fund­ing and ser­vice pro­vi­sion re­spon­si­bil­i­ties sees (in very broad terms) the state and ter­ri­tory gov­ern­ments re­spon­si­ble for hospi­tal ser­vices, and the fed­eral Gov­ern­ment re­spon­si­ble for fund­ing GPs and aged care ser­vices.

The ten­sions in­her­ent in this ar­range­ment were on full view in the re­port re­leased last week by the eight state and ter­ri­tory health min­is­ters, called Car­ing For Our Health?, com­ment­ing on the fed­eral Gov­ern­ment’s record on health fund­ing. This re­port is a clear demon­stra­tion of the pit­falls in­her­ent in the cur­rent fund­ing ar­range­ments, and fur­ther ev­i­dence that blame shift­ing be­tween the states and the fed­eral Gov­ern­ment takes prece­dence over co-oper­a­tive ap­proaches.

While most users of health care ser­vices are not con­cerned about what level of gov­ern­ment is pro­vid­ing their care, the di­vi­sion means when peo­ple move be­tween ser­vices, for ex­am­ple from a (fed­er­ally funded) gen­eral prac­tice to a (state/ter­ri­tory funded) hospi­tal, they are mov­ing in a sep­a­rate ‘‘ sys­tem’’. Very of­ten their in­for­ma­tion and records of their care do not travel with them. Lack of co­or­di­na­tion and fail­ure to trans­fer vi­tal in­for­ma­tion not only risks the safety and qual­ity of care to in­di­vid­u­als, but costs money when tests and in­ves­ti­ga­tions are re­peated, med­i­ca­tions re­ordered, and so on. It also means that no sin­gle provider clearly takes re­spon­si­bil­ity for the pa­tient — lead­ing to poor con­ti­nu­ity of care and wasted money and re­sources.

Other ex­am­ples of cost-shift­ing and the con­se­quent in­ef­fi­cien­cies in­clude that of (state/ ter­ri­tory funded) emer­gency de­part­ments be­ing over­run by peo­ple who are un­able to get an ap­point­ment to see a (fed­er­ally funded) GP. Or the sit­u­a­tion where el­derly peo­ple, un­able to ac­cess a (fed­er­ally funded) aged care bed, are forced to lan­guish in a (far more ex­pen­sive, but state/ter­ri­tory funded) hospi­tal bed.

Sim­ply put, the sep­a­ra­tion of fund­ing streams leads to cost-shift­ing, frag­men­ta­tion of ser­vices, du­pli­ca­tion of ser­vices and mas­sive in­vest­ments in ad­min­is­tra­tion in an ef­fort to try to co-or­di­nate it all, much of which could be re­duced and qual­ity of care im­proved if the sys­tem was re­formed.

One po­ten­tial so­lu­tion is the cre­ation of a sin­gle fund­holder re­spon­si­ble for fi­nanc­ing all of the ser­vices pro­vided to a pa­tient. This was ad­vo­cated in the 2004 re­view of the Tas­ma­nian hospi­tal sys­tem, toyed with in the Queens­land Health Sys­tems Re­view in 2005, and was ap­par­ently a key rec­om­men­da­tion of the 2006 re­view un­der­taken by for­mer health de­part­ment head Andrew Podger. Podger’s re­port, how­ever, has never been re­leased, pre­sum­ably re­flect­ing the fed­eral Gov­ern­ment’s lack of en­thu­si­asm for the rec­om­men­da­tions.

The ar­gu­ments for a sin­gle fun­der are that it would have the ef­fect of re­duc­ing much of the ad­min­is­tra­tive in­ef­fi­ciency, mak­ing ser­vices more cost-ef­fec­tive, and en­sur­ing a seam­less tran­si­tion be­tween all of the ser­vices pro­vided to a sin­gle in­di­vid­ual. (A sin­gle fun­der does not mean a sin­gle sup­plier — ser­vices are gen­er­ally best pro­vided clos­est to the pa­tient.)

There is no short­age of pro­po­nents of this idea: it has been cham­pi­oned by many, in­clud­ing John Me­nadue of New Matilda and the Cen­tre for Pol­icy De­vel­op­ment and Jeff Richard­son, econ­o­mist and for­mer chair of the Tas­ma­nian re­view. Even the fed­eral Gov­ern­ment’s own in­quiry re­port, The Blame Game, re­leased in Novem­ber 2006, fol­low­ing a year­long House of Rep­re­sen­ta­tives stand­ing com­mit­tee in­quiry into health fund­ing, called for a na­tional health agenda, al­though it stopped short of an in­sis­tence on fund­ing re­form. De­spite ac­knowl­edg­ing the ‘‘ iden­ti­fi­able ben­e­fits’’, the com­mit­tee baulked at the ‘‘ sub­stan­tial pe­riod re­quired to in­sti­tute the ar­range­ments’’.

A na­tional approach to health, in­deed a na­tional health pol­icy (Aus­tralian does not cur­rently have one), could well pro­vide di­rec­tion and help to ad­dress ju­ris­dic­tional in­ef­fi­cien­cies. The Aus­tralian Health Care Re­form Al­liance ad­vo­cates the es­tab­lish­ment of a Na­tional Health Re­form Coun­cil (NHRC) to drive this pol­icy agenda.

Dif­fi­cult though re­form might be, tak­ing no ac­tion, and find­ing our health sys­tem also at five min­utes to mid­night, is surely not an op­tion. Re­form is nec­es­sary, in­evitable, and like ad­dress­ing cli­mate change, re­quires bold and vi­sion­ary ac­tion.

As the fed­eral elec­tion ap­proaches, Aus­tralians who care about health should be watch­ing closely to see which of the par­ties will be brave enough to en­sure Aus­tralians will have ac­cess to af­ford­able, eq­ui­table, qual­ity health ser­vices into the fu­ture. Fiona Arm­strong is a mem­ber of the ex­ec­u­tive com­mit­tee of the Aus­tralian Health Care Re­form Al­liance, a coali­tion of 44 or­gan­i­sa­tions rep­re­sent­ing con­sumers and health care providers ad­vo­cat­ing for a fairer and more ef­fec­tive health care sys­tem.

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