Ser­vices must be of­fered on needs ba­sis

The Weekend Australian - Travel - - Resources - FIONA ARM­STRONG

THE prin­ci­ples pub­lished this week by the Na­tional Health and Hos­pi­tals Re­form Com­mis­sion (NHHRC) are laud­able, and if they un­der­pinned a na­tional health sys­tem might pro­vide a de­cent foun­da­tion for the sys­tem in Aus­tralia. But the dif­fer­ence be­tween the­ory and ac­tion can be vast, and there is much to im­prove about our health sys­tem if we are to have any hope of pro­vid­ing uni­formly qual­ity ser­vices and de­cent health out­comes for all Aus­tralians.

Fun­da­men­tal re­form to the way we fund and de­liver health ser­vices in Aus­tralia is ur­gent. We’re strug­gling now to de­liver safe ser­vices in our hos­pi­tals, peo­ple are be­ing de­nied health care be­cause they can’t af­ford it, and peo­ple in rural and re­mote ar­eas and in­dige­nous Aus­tralians are sub­si­dis­ing (with their own poorer health out­comes) some of the over-ser­vic­ing that is oc­cur­ring in our most af­flu­ent cities.

It is fre­quently claimed that we have a world class health sys­tem, but don’t be fooled. Ac­cess to health care ser­vices in Aus­tralia is dic­tated by so­cioe­co­nomic cir­cum­stance and ge­o­graph­i­cal lo­ca­tion; the health work­force is in­creas­ingly de­pleted and de­mor­alised; in­dige­nous Aus­tralians are still suf­fer­ing Third World health out­comes; and largely pre­ventable chronic ill­nesses are cre­at­ing a huge bur­den for the acute health sys­tem.

All of this de­mands ac­tion, and that ac­tion must be­gin with the de­vel­op­ment of a shared un­der­stand­ing be­tween gov­ern­ments and the com­mu­nity about what we want from our health sys­tem and how much we are will­ing to pay for it. This is re­flected in the Com­mis­sion’s draft prin­ci­ples, but it must go fur­ther than that — a gen­uine com­mu­nity con­sul­ta­tion is re­quired to help shape the un­der­ly­ing val­ues and pri­or­i­ties of a com­mon fu­ture na­tional health sys­tem.

A con­sul­ta­tion un­der­taken by the Aus­tralian Health Care Re­form Al­liance (AHCRA) last year showed that if given the op­por­tu­nity, cit­i­zens are adept at iden­ti­fy­ing some of the core build­ing blocks of a fu­ture health sys­tem. The re­al­ity is we can’t have an in­ten­sive care unit on ev­ery cor­ner. It may not be prac­ti­cal (or eco­nomic) to have three hos­pi­tals in one city per­form­ing the same spe­cial­ist surgery. Ac­cess­ing an emer­gency de­part­ment may be a lower-or­der pri­or­ity for some com­mu­ni­ties who just want good pri­mary health care — to keep their kids healthy, their el­derly rel­a­tives at home, and to keep them all out of hospi­tal for as long as pos­si­ble.

That may be pos­si­ble. But get­ting the sys­tem that we need re­quires tak­ing the op­por­tu­nity to have in­put into that con­sul­ta­tion to ev­ery per­son in Aus­tralia — not just those who have ac­cess to the in­ter­net, pro­fes­sional lob­by­ists, or those with spe­cific in­ter­ests and agen­das. As well as de­vel­op­ing a long-term plan for re­form, the Na­tional Health and Hos­pi­tals Re­form Com­mis­sion is also look­ing at ways to im­prove our pub­lic hospi­tal fund­ing. The pres­sures to do this are con­sid­er­able, along with the sums of money in­volved: $100 bil­lion was spent on pub­lic hospi­tal ser­vices in Aus­tralia in the past five years.

An ex­tra $1 bil­lion has now been of­fered to the states from the fed­eral Gov­ern­ment to ad­dress fund­ing short­falls. The ex­tra fund­ing is wel­come, but it will not have any im­pact un­less there are im­prove­ments in the trans­parency and ac­count­abil­ity to en­sure the funds are spent on cost-ef­fec­tive, ap­pro­pri­ate ser­vices.

In the past the re­quire­ments for re­port­ing out­comes have been too few; the obli­ga­tions to de­liver safe, high-qual­ity ser­vices in­ef­fec­tive; and the siloed fund­ing of hospi­tal ser­vices as dis­tinct from com­mu­nity care, aged care, and pri­mary health care, have led to poor co­or­di­na­tion of care.

How­ever, there is an even larger void in na­tional health pol­icy gen­er­ally. We have no sin­gle com­mon vi­sion and frame­work for our health sys­tem in Aus­tralia. Com­pre­hen­sive, long-term health re­form is the only an­swer.

Sus­tain­able long-term re­form will, there­fore, need the de­vel­op­ment of a con­sid­er­ably strength­ened frame­work of co-op­er­a­tion than has ex­isted be­tween our gov­ern­ments over re­cent decades, which ex­tends be­yond the cur­rent play­ers.

The de­vel­op­ment of prin­ci­ples by the Com­mis­sion is pre­ma­ture — the NHHRC must be­gin with an un­der­stand­ing of what health ser­vices will best meet the needs of our cit­i­zens. De­ter­min­ing those needs re­quires con­sul­ta­tion with the Aus­tralian peo­ple about the kind of health sys­tem they need and want, both now and in the fu­ture.

Once we know what sys­tem we want, what ser­vices we need and how we want to de­liver them, we can then de­sign a sys­tem that will best fa­cil­i­tate it.

The fun­da­men­tal prin­ci­ples of this new health sys­tem must be the pro­vi­sion of uni­ver­sal pub­licly funded ser­vices avail­able to peo­ple on the ba­sis of need, not their abil­ity to pay — and a sys­tem which ac­cepts ac­cess to health care as a hu­man right.

Us­ing this as a start­ing point, with ex­ten­sive com­mu­nity con­sul­ta­tion, will help en­sure Aus­tralia’s health sys­tem is not only safer and more ef­fi­cient, but that it is fairer and more eq­ui­table into the fu­ture. Fiona Arm­strong is the Chair of the Aus­tralian Health Care Re­form Al­liance.

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