Much need, but stay-on-course bud­get likely

The Weekend Australian - Travel - - Resources - PETER BROOKS

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

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