Services must be offered on needs basis
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.