JOHN DWYER An open letter to Minister Greg Hunt

May 24, 2019


The majority of Labor’s plans for our health system were greeted with enthusiasm herein and elsewhere as they addressed major current inadequacies that diminish the equity and cost effectiveness of the health care available to Australians. Labor did seek and act upon advise re health reform priorities provided by health professionals and informed consumers. They took to the election an ambitious plan (too ambitious say many post election pundits) that would have facilitated needed structural reforms (An Australian Health Care Reform Commission) and address a range of imperatives I present here in an open letter to health minister Greg Hunt

Dear Minister Hunt,

Australians have demonstrated their confidence in the Coalition governing the country well for a further three years. With the air clear of Politics for the moment the implementation of Policies must now take centre stage. I am confident that with your experience as our health minister you would have analysed all of the health plans forwarded by Labor and recognised that many had merit. They were warmly welcomed by most Australians who, I am sure, would be very frustrated if you were not to pursue a number of the obvious imperatives addressed simply because they were espoused by the opposition.

An overview of our health system’s problems emphasises our enormous and increasing expenditure caring for Australians with chronic diseases yet we still fail to provide our primary care system with the infrastructure to effectively tackle disease prevention. We spend less than 2% of our health budget on prevention. We spend more than 55 billion dollars a year on hospital care. The average cost of a public hospital admission is around $6000 and around 700,000 of these each year could be avoided if primary care was supplied with the necessary infrastructure. The burden from chronic but avoidable disease results in much suffering for those effected and our health budget.

World wide, the emphasis on primary care utilising “team medicine” models is reducing the burden of disease and the need for hospitalisation. You have “flirted” with a diluted version of this model with your “Healthcare Home” model which has failed to meet expectations as the model can’t deliver true integrated care and does not address prevention at all. Recognising the need to introduce changes to Primary care to meet our expectations, Labor was planning to establish a Health Care Reform Commission initially tasked with addressing better models of care for Primary Care. I would urge you to do something similar. As welcome as your promise is to spend an extra $187 million to re-index items such as health assessments, urgent after-hours care and GP mental health and residential management this is after all to be paid for by no longer making savings of $187 million by continuing to erode the value of the rebates andBoth parties the rate of indexation. What we really need now is your championing of basic structural reforms to the primary care system

We are grateful for your championing of the availability of new drugs through our PBS but, in general, these drugs benefit relatively few off us whereas greater expenditure on Primary care to improve the health of the Nation would provide benefits to millions. Minister, billions of additional dollars to increase the bed capacity of our hospitals were promised prior to the election. While in the short term there is no doubt that the public hospital sector needs more money, the provision of the needed dollars should be matched with dollars for strategies to reduce the need for more hospital beds.

We need you to address the fact that Australians spend more than 30 billion dollars a year in “out-of-pocket” health care expenses, a reality which makes a mockery of our claims to provide tax-payer funded universal health insurance. One major initiative Labor was to pursue would see targeted funding re-establishing specialist out patient (OPD) clinics in our major hospitals. Funding shortages have resulted in public hospitals diverting OPD funds to emergency and in-patient services. Our Prime Minister, in commenting on the out-of-pocket payments required from patients with cancer, claimed recently, that if you sought your care in a public hospital all service would be free. This is currently not the case but restoring OPD funding, including imaging and pathology, could make it so as well as enhancing hospital teaching and research programs which we regret losing. This initiative certainly should receive bi-partisan support. Labor’s plan to ask cancer specialists to accept a common fee for their services may well have been difficult to achieve and I suspect reducing the costs of cancer care would ultimately have required greater public hospital funding for such services to achieve “free” cancer care for many more of us.

As you are aware dental care for many Australians is a a basic service that for many is unaffordable. The extent of dental pathology in our wealthy country is a national disgrace. Oral health is directly related to overall health and it is, in retrospect, regrettable that it was not included in the range of services to be offered by”Medicare”. Children in New Zealand have far better oral health than Australian children because dental care for children is supported in the country’s national health scheme.Labor’s plan to start addressing this problem by helping seniors access dental care was an important and very well received initiative and it is more than reasonable for Australians to anticipate that you will address this problem as a matter of urgency in this next term of government.

In summary debate during the election season saw defects within our health system recognised and welcome improvements suggested such as your plan to start the process of better using IT communications in General Practice and Labor’s plan to address dental health problems. Both parties agree that prescription costs need to be reduced. Political maturity that would see your government accept the best of the suggestions forwarded by all parties would be welcomed, even refreshing. We must have system that embraces the primacy of prevention to reduce the burden of chronic life-style induced illness which in turn would result in a reduction in the number of public hospital beds needed for patients with chronic medical problems, with those available allowing public hospitals again offer reliable surgical services to Australians. The next three years under your stewardship will hopefully move us much closer to this goal. More than happy to further discuss these imperatives

Yours sincerely,

Professor John Dwyer , Emeritus Professor of Medicine UNSW, was a foundation member of the Goulston Health Reform Group and Founder of the Australian Healthcare Reform Alliance (AHCRA).


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