At last, we have a vision for a better and fairer health system
NATIONAL policy-makers and politicians are slow to act when it comes to big national public policy decisions. Careful consideration is naturally prudent when major changes are required. Research data must also be gathered to ensure that any reform is evidence-based and likely to be effective.
The ALP’s recent announcement about health reform aimed at reducing the blame game, removing the inefficiencies between different levels of government, and focusing the system on prevention and health promotion is a very positive step towards ensuring Australians will have access to safe, affordable, equitable, health services into the future.
Further action is necessary because the sustainability of a safe, high quality, universal health system for Australia is under threat. While less evident in current political debates than say, interest rates, the current dysfunctional structure of the nation’s health care system poses real risks to the population.
The universal nature of Medicare must remain an absolute commitment. Universal health insurance is not only the fairest and most efficient means of sharing health costs, but is also immutable in terms of access to health care as a human right. Anyone who doubts this imperative need only see US filmmaker Michael Moore’s movie Sicko to be quickly disabused of any notion that handing over health care to the for-profit sector might be a good idea.
In our current system, out-of-pocket costs are increasing, putting essential health care beyond the reach of many low-income Australians. A recent international comparison of health care by the Commonwealth Fund (USA) revealed 34 per cent of Australians have either not filled a prescription, had a health problem but didn’t see a doctor, or failed to complete a recommended medical test, treatment or follow-up, because of cost. And 43 per cent of Australians have needed dental care but could not afford it.
Well-documented workforce shortages across the health system also mean access to services is becoming increasingly difficult. Safety and quality of care are inevitably affected: around 10 per cent of people admitted to hospital suffer harm directly related to their health care, and each year, up to 18,000 people die as a result of the health care they receive. Indigenous Australians are suffering Third World health outcomes. Largely preventable chronic illnesses are creating a huge burden for the acute health system.
These are not the characteristics sustainable system.
Health policy-making in Australia seems to have lost sight of the ultimate goal: to promote health and provide high quality care to those who are sick. Even the bottom line to ‘‘ do no harm’’ often fails to be met. Large-scale policy planning is missing. Health policy is largely determined by the squeakiest wheel, which
a inevitably means that only the most powerful vested interests, capable of resourcing a sustained campaign, are able to elicit the policy outcomes they seek. How did it come to this? A major problem is the different levels of government in charge of different types of services, with the inevitable outcome that when services fail to deliver, each level of government blames the other. And thus, billions of precious health dollars are being wasted each year. Only by eliminating the opportunity for cost and blame shifting can we have truly accountable systems that are transparent, evidence-based, and use resources efficiently.
There are several key stakeholder alliances in the Australian health sector deeply concerned about the current state of Australia’s health system. The term ‘‘ system’’, however, is a misnomer, since it suggests some level of coordination, while the reality is that the socalled system is in fact a series of many thousands of disconnected programs.
The communique from the recent National Health Reform Summit, convened by the Australian Health Care Reform Alliance, called for all governments to move to work collaboratively to improve the delivery of safe, affordable, equitable, and efficient health services and commit to a program of reform that acknowledges health care as a human right and which will meet the needs of the Australian community into the future.
The development of a national health policy to ensure coherent national health services planning is a key recommendation. What is the vision for the Australian health sector for the next 10, or 20, years? How can we do anything other than ‘‘ putting out fires’’ without a national plan? As recognised by Labor, a national health reform commission is also required, as an independent body, to develop a long-term national health reform plan, monitor performance against agreed goals and regularly report its findings publicly.
Cost-shifting could be overcome if the many disparate sources of federal and state public health funds are pooled, and then distributed throughout the jurisdictions according to need. This would ensure not only accountability, but improve administrative efficiency, make services more cost-effective, and ensure a seamless transition between all of the services provided for a single individual.
Eighteen key recommendations agreed by the members of the alliance accompany the summit’s communique as further details of necessary reforms.
All health professionals are working hard to deliver the best possible care with the resources available to them. But the complex nature and inefficient structure of the ‘‘ system’’ is working against them. The ALP’s recent announcements are the first sign, in this election campaign, that someone in Canberra has the vision to take a positive first step towards a better, more equitable and more efficient, health system. Fiona Armstrong is a member of the executive committee of the Australian Health Care Reform Alliance, a coalition of 43 organisations representing consumers and health care providers advocating for a fairer and more effective health care system.