Pearls and Irritations

Health policies presented as part of the election campaign should address our expectations for prompt, courteous and effective high-quality care when we need it and not be a random collection of thought balloons – from a child’s birthday? – about waiting lists and co-payments .

Health care is essential to achieving goals for more jobs and a brighter budget. Its availability to all is a fundamental of fairness. Labor or Coalition, health policy is critical to what they hope to achieve for us. Here is why we should be hearing a national health policy from the contestants.

First, we are dithering about the support for general practice. A review of general practice initiated by the current government proposed ways to care for patients with complex and chronic problems. But financial arrangements that recognise the need for continuity in care and the help of non-medical health workers were not well developed.

The medical literature is awash with variations on integrated care, as this is called, in North America, New Zealand and Europe. Past attempts to provide care this way in Australia have failed and the reasons need careful analysis and avoidance. They have to do with unrealistic assumptions about GPs as managers and muddled methods of payment.

What do patients with chronic problems really need? Our own and others’ studies highlight that continuous, dependable 24/7 access to a practitioner who knows the patient and in whom they have trust is essential.

City general practice has moved away from this principle with part-time employment being the norm and the use of deputising services out of hours. Rarely do such services have access to the patient’s medical record and rarely does the deputising doctor know the patient.

Continuous care need not be provided by a medical practitioner – indeed, effective care has been demonstrated when the primary carer in the 24/7 cycle is a nurse suitably informed, trained and with electronic access to the patient’s record. Admissions to hospital can be reduced through trust, knowledge of the patient and conservative conversation. We have shown such measures to reduce hospital admissions by 50%.

Second, a health policy for Australia needs to grasp the urgency and complexity of prevention instead of running away from it. Obesity, diabetes, heart disease, stroke, mental illness, addiction, forms of cancer and injury, have their origin in our trade, commerce, industry and education and town planning. Now there are challenges for politicians with muscle, brains and determination to tackle.

It has taken us 60 years to come to terms with tobacco, and food, alcohol and the physical environment where good is blended with bad will take us longer. The strategies to address these national problems will be national, worked out locally. We should hear about them as part of the national election.

Third – and here is the moral moment. Jobs and growth and equity and fairness are international matters. Health in Australia is inseparable from health in our region and beyond. Six million children in developing countries died in 2015 from preventable diseases of which Australia is blessedly free. But our national government should reflect the moral concern of its citizens for those who live beyond our shore and say what we might do to help to improve their health.

Cuts to foreign aid are cuts to education and health care of these children. We may be an island people, but we are not isolated.

Stephen Leeder is an emeritus professor in public health at the University of Sydney.

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