Much need, but stay-on-course budget likely
WHAT will Tuesday’s federal budget bring to resuscitate the health system? Can the various lobby groups be kept reasonably happy while a new approach to health policy and funding is commenced? Kevin Rudd’s handpicked health reform commission, the National Health and Hospital Commission, made initial recommendations this week.
Among them is a call for the commonwealth to wrest some health roles from the states, including running community and mental health services. It also proposed assigning specific health responsibilities to each level of government so voters will know who to blame for problems such as long-waiting lists for elective surgery at public hospitals, and inadequate emergency services.
Such recommendations are a good start. But it would be unwise to bring in significant change until the group’s final report later this year. Meanwhile, though, some things must be tackled now. Those long waiting lists and overcrowded emergency departments continue to gain media attention. The gap in longevity and health outcomes between the wider community and the disadvantaged — particularly our indigenous community — continues.
Clearly, we have not really funded disease prevention to any extent at all, so let’s see something for health and not just for disease. We have to be serious about the disease prevention budget, so what about a long-term strategy to increase spending in this area from around 7 per cent of the health budget to 20 per cent by 2020?
At the same time, we do need some money to reduce waiting lists and keep emergency departments open, and there must be incentives to require hospitals to develop a prevention agenda as well.
Ensuring we have an effective and adequate health workforce is not just a serious national problem. It’s an international problem. We must stop recruiting doctors and nurses from countries needing them far more than we do.
Developing a prevention agenda will, in the long run, reduce the demand on the health system and help Australia achieve a sustainable health workforce by 2020.
To really make a difference, though, it’s essential that we broaden access to the Medical Benefits Schedule (MBS) to encompass allied health professionals such as physiotherapists, occupational therapists, pharmacists and others. These professionals could help cut waiting lists in outpatient facilities for things such as back pain, hip and knee arthritis, incontinence and numerous other conditions for which there is good evidence that such experts can make a difference.
And what about real incentives to further develop practice nurses, nurse practitioners and new types of middle-level practitioners such as physician assistants?
There are about 70,000 of these well-trained professional in the US alone. They work closely with doctors to do a whole raft of health activities from primary care, emergency room care to even sewing up former US president Bill Clinton’s coronary arteries.
These middle-level practitioners could work with doctors to do some of the tasks they find repetitive, thus improving efficiency in the health system. Let’s remember that health care is team work. Everyone has a part to play, even the patient.
Let’s also see some real incentives in the health system itself. As the reform commission recommended, it’s time to reduce duplication within state and commonwealth departments and within hospitals. The Productivity Commission’s report on the health workforce some two years ago predicted savings of over $3 billion a year if hospitals adopted standard good-business practices.
Finally, it’s absolutely essential to adopt new technologies such as telemedicine to provide access to specialist services — medical and non-medical — across our vast land.
The technology is available but it won’t be used if it’s not properly funded. That means MBS item numbers must be established for telehealth consultations.
No one blinks when their lawyer sends a bill after providing telephone advice. What’s different about a health professional doing the same? Their services might even be more therapeutic.
There are many other steps that can and should be taken. For instance, we need more funding for what are still the best investigation’’ practices in health care — good patient histories and physical examinations.
We need real incentives to boost the health literacy of all Australians. We need to review the MBS to ensure we’re spending precious health dollars on evidence-based medicine and medications.
Will we? My bet is that this will be a steadyas-she-goes budget for health with the real changes to come in 2009. Professor Peter Brooks is executive dean of the Faculty of Health Sciences at the University of Queensland and interim director of the Australian Health Workforce Institute