JOHN DWYER – Will the health initiatives announced last week significantly and sustainably improve health care for Australians?

Apr 8, 2019


Given that polls constantly have Australians saying that healthcare is a top issue in every election, expectations are high that our politicians will describe a commitment to those structural reforms so badly needed to improve equity of access to excellent health care that is cost effective. While Labor had made a number of important announcements over the last few months that were not presented in Bill Shorten’s speech (worrying) the Coalition only announced one major new program that is problematic to say the least.

Australians are looking for relief from the extraordinarily high out-of-pocket expenses required to supplement our “free” universal health insurance scheme. These additional expenses amounted to 30 billion dollars last year. Australians are well aware of how easy it is to fall into the obesity trap with all its downstream consequences and have been enthusiastic about primary care being restructured to place an emphasis on prevention. Let’s have a system, adopted now by many other countries, focused on wellness not the management of so much avoidable chronic illness.

Even average Australians who don’t have much time to focus on our health care system are frustrated, even disgusted with the constant “blame game” that has the Commonwealth and States arguing about who should pay for what. Once in the system because of a need to mange an illness there is often great frustration at the lack of integration of the care needed with poor communication between those that are trying to help.

Then there is the spiralling costs of Private Health Insurance where wealthier Australians are advised by their accountants that being uninsured will cost you more and many who really struggle to pay the premiums feel forced to do so as they feel they cannot be confident that the public hospital will be available when they need it. Our major hospitals have trouble coping in terms of capacity and a fixed budget with ever increasing demands for admission. Budget restrictions have seen many hospital based outpatient clinics, where one could once see a specialist at no cost, remove such a service. People are forced to seek out specialist care in the private sector. Fees can be very high.

So were these imperatives addressed by our politicians this week in their budget speeches? With the Coalition it was case of continuing with current policies. They would lift the unfair freeze on Medicare payments to doctors which, never sufficient for such highly trained specialist, saw their income in real terms shrinking. While welcomed this may see doctors receiving an extra dollar for a standard consultation ( don’t book the plane to Hawaii yet!)
The major Coalition offering in the health sphere is aimed at improving aged care services offered by GPs; a worthy goal. The program is only sketched out but the known facts that are on the table involve money to help GPs offer services to the aged without the need for a face to face consultation. GPs would enrol patients for the service ( bureaucratic time involved) Minister Hunt commented “GPs and others in their practice will be able to provide consultations, referrals, scripts and test results remotely i.e. without seeing patients face-to-face,This will make it easier and more convenient for people to access timely care and medical advice.”
However, Mr Hunt declared that the scheme would be backed by $449 million but has yet to reveal important details such as how much funding each patient would attract and what work GP practices would be expected to undertake in return for the fee. The College of General Practitioners has done some sums.

Dr Harry Nespolon, President of the college noted that “It isn’t $450 million per year; it is that amount over the next three years. You can do the maths with about 2.65 million Australians over 70, it does not add up to very much money per patient.” In fact if all eligible availed themselves the additional services would see doctors receiving $69 per occasion of service but only once per year! Most 70 years are already enrolled in a GP practice and surely it’s likely that many are not ready to avail themselves of the technology required so funding for training would be important. In summary The Coalitions contribution to improving our health system is disappointing.

What about Labor’s promises? Unlike Morrison’s address which covered all the know health related promises being taken to the election by the Coalition, Shorten’s team have been talking up (promising) initiatives not mentioned in his speech to the House but which for many of us interested in structural reforms to our health system are even more important than what was addressed in his speech. Shadow Health Minister, Catherine King has been repeating the promise that Labor will set up an Australian Health Care Reform Commission as a creature of COAG, thus gaining support from State and the Commonwealth, to advise government on structural reforms and, if approved, implementing same. Here is the potential to address those consumer frustrations mentioned above. I have written extensively herein on the role such an organisation would play. Associated with that promise is a guarantee that well funded  specialist outpatient clinics in public hospitals would be restored. I wish these initiative had been mentioned in the speech to parliament for to date, they have received very little publicity. Perhaps they were deemed too complicated for the speech and far less sexy than Cancer

Which brings us to the Health item that dominated Shorten’s speech, free (Medicare funded) cancer diagnostic tests and treatment for all. Mr Shorten promised “funding for up to 6 million free medical scans and 3 million specialist consultations with no out-of-pocket costs for existing and future cancer patients’’ This is estimated to cost $2.3 billion over four years.
It includes $600 million for free X-rays, ultrasounds, mammograms, computed tomography (CT) scans, PET scans and magnetic resonance imaging (MRI) .

It also includes $433 million for free consultations with oncologists and surgeons, turning these services into bulk-billed Medicare items so patients would no longer have to cover up to 40 per cent of the cost under current rules.
The most expensive part of the plan is a “guarantee” that every cancer medicine recommended by experts will be subsidised by the Pharmaceutical Benefits Scheme.

Sounds wonderful and it is but negotiating with all the involved players will be very difficult but not impossible. Having oncologists and surgeons agree to accept a common fee will see a major departure from current practices where some surgeons charge 5 times more than some colleagues. I presume palliative care will be included though it is not stated. Charges from diagnostic imaging services vary considerably. Here is a situation where an appropriately skilled Reform commission could negotiate with the cancer craft groups to read this goal.

In any case there is no doubt that Labor’s health plans are far worthier of voter support than those of the Coalition.

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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