JOHN DWYER. Labor unveils the health care reform initiatives to be pursued if elected.

Feb 18, 2019

Shadow health minister, Catherine King, in an address to the National Press Club, has detailed the major health initiatives Labor would embrace if elected in May. Her plans indicate that she has heard and accepted many of the priorities for reform proposed by would be health reformists. The status quo is unacceptable. Most encouraging was her recognition that patient-centred reforms, which must include truly integrated care, was impossible if the current jurisdictional division of responsibility for health care continued. The portfolio of reforms she presented are welcomed and would be readily understood by electors if they could hear these plans. Fears were expressed at her presentation that totally unjustified scare tactics about boarder security might so dominate election debates that these important promises might get little attention. Certainly there has so far been very little media reporting on the health initiatives announced with some of the few comments made by journalists suggesting they did not understand the proposals.

So what’s on offer? There are three most welcome initiatives. First, the establishment of an Australian Healthcare Reform Commission (AHRC) as a statutory, permanent body charged with continuous improvement of our health care system. The Commission would have a broad mandate, but initially focus on needed reforms to Primary Care and prevention, one of the shadow ministers “passions”. Second, the restoration of speciality outpatient clinics in our major hospitals and third, the reinstatement of funding promised to public hospitals, but withheld by the current government.

Readers of P&I will know that there have been numerous articles stressing the importance of a reform commission. John Menadue has long emphasised the importance of an AHRC in neutralising the reform inertia induced by those vested interests that have generated political intransigence. Recently I noted:

The next Federal government must create an Australian Health Care Reform Commission (AHCRC) to manage the reform process. This must be a creature of COAG that is one supported by all our governments and reporting to the COAG Health Council. The commission should eventually morph into the Australian Health Care Commission funding and therefore integrating all aspects of our public health system. This would at last see an end to the “blame game” between the States and the Commonwealth. The Whitlam government created such a structure only to have it dismantled by the Fraser government. Its creation now is absolutely essential. Labor was exploring the idea before the last election and it is to be hoped that they remain committed.

Well the HCRC proposed by Labor embodies these recommendations. As urged by many, the Commissioners will be appointed for five year terms, a move to remove any pressures related to our short election cycles. There is an emphasis on long term planning which has historically been absent. King envisions the HCRC enjoying the trust and respect currently enjoyed by the Productivity Commission. She told her audience that the HCRC would be charged with reducing inequality in access to healthcare of excellence. It would report to COAG and the COAG Health Council. When asked why the Department of Health could not do all that she would be asking of an HCRC and should this initiative not be seen as just “more bureaucracy” she correctly emphasised that for this vision to become reality, an enthusiastic partnership between States and Territories with the Commonwealth was essential. Welcome, was her commitment to the deliberations of the Commission being available to the Australian public.

The second, very much appreciated initiative announcement, demonstrated Labor’s understanding of the importance of all Australians having affordable access to medical specialists when needed. Currently many cannot afford such care and for those who can, the expense contributes significantly to the unacceptably high “out of pocket expenses” Australians pay for healthcare ($30 billion a year and rising).

For many decades one of the most valuable contributions our major hospitals made to health care was the specialist outpatient clinics they hosted and funded. Aside from offering equality of access to specialist services, such clinics were invaluable places for teaching undergraduate and post-graduate students. They also provided significant opportunities for clinical research. Their demise was associated with cuts to public hospital funding which saw them necessarily focusing on inpatient services. Such clinics, if they were retained at all were designated ‘private’ in that the fees associate were billed to Commonwealth (through Medicare) and over time patients were asked to make a co-payment for such care. The result, as recognised by King, is that specialist care is beyond the means of many Australians, making a mockery of our claims to health care for all based on need, not personal financial well-being.

Which brings us to the third of the major initiatives. Labor is not only to support the restoration of outpatient specialty clinics, but is promising to return to hospitals the $2.8 billion cut from hospital budgets by the Coalition and will again offer the States a deal whereby the Commonwealth will pay for 50 per cent of any growth in service costs.

Other welcome plans include significant funding for research into Ovarian cancer, lifting the six year-long freeze on Medicare payments which has deprived the system of some three billion dollars, funding trials of different models of primary care, strengthening the research future funding program, increasing the number of licences for MRI screening, and for two years, capping the annual increase in the cost of private health insurance at two per cent. Labor will not increase the Medicare levy.

There were a few disappointments. Labor has no intention of removing the taxpayer funded support for private health insurance. At $11 billion a year this is a poor return on investment and King’s view that poorer Australians could not afford private insurance without government support should be balanced with the removal of the need for such Australians to seek additional insurance. As her reforms make public hospitals, once again, reliable places for timely medicine, the private health rebate will become increasingly unnecessary.

King’s accurate referral to the difficulty of reforming primary care when doctors receive a fee for service was not linked to any plans to move away from this unsatisfactory method of remuneration with its emphasis on quantity of service not demonstrable quality of service. Surely her HCRC will quickly conclude that this is an essential step in improving primary care?

Overall there was much to enthuse about in Labor’s vision for improving equity, cost effectiveness and quality in our delivery of health services. More details are promised and they will be important. It is to be hoped that Australians get a chance to hear and consider the above reforms, which I feel would be strongly supported. However, news of these plans could all to easily be drowned out in the pre-election weeks if the governments hysteria about the devastating effects on national security inherent in our offering much needed medical care to 1000 trapped and abandoned refugees dominates the election news cycle.

Professor John Dwyer AO, PhD, FRACP, FRCPI, Doc Uni (Hon) ACU, Emeritus Professor of Medicine UNSW and Founder of the Australian Healthcare Reform Alliance

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