At last, we have a vi­sion for a bet­ter and fairer health sys­tem

The Weekend Australian - Travel - - Health - FIONA ARM­STRONG

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.

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