Congratulations on your impressive achievement. It is now time for policy implementation. I hope you have a huge agenda. Supporting Medicare is not enough. Our health needs have changed and we know much more about what is needed to meet those needs than we did when Medicare was introduced. We have to embrace the changes and reform Medicare.
But the first task you have is to save the lives of some of the 50 people a day who are dying of Covid because the daily impact of the virus has been forgotten by politicians and journalists. That’s equivalent to a plane with 350 people on it crashing every week, all dead. Too many people are simply not aware that the daily death toll has been rising since March. Many of my patients are taken aback when I show them the figures. You can save lives now. It’s easy. No legislation is required. Just get in front of the cameras and microphones and beg people to get their third and fourth vaccination, wear masks indoors and be careful. Most who get Covid won’t get serious disease but for the sake of those who do, the minor inconvenience of masks could save a loved one’s life.
Reducing Covid cases will also help alleviate the crisis in public hospitals. However the next task is to get on with fully implementing the Aged Care Recommendations as quickly as possible to restore the dignity and improve the health of our vulnerable elderly. This will also help public hospitals by reducing unnecessary time spent in hospitals by our these people, waiting for a Home Care Package or a bed or unnecessarily admitted to hospital because of inadequate care.
Your intention to review the NDIS is desperately needed. If the improvements introduced are the right ones this will also help the public hospitals by limiting unnecessary admissions and time in hospitals. It will make primary health care for those with disability much easier to access and co-ordinate.
Primary health care is in increasing disarray. The GP workforce is aging and unable to provide adequate timely access. Co-ordination of care is chaotic even when access to the spectrum of care is available. Primary Healthcare Networks are improving but have quite limited capacity. Fee for service funding is inappropriate for chronic disease. Your support for voluntary enrolment is welcome. The next step is to introduce a capitation payment based on enrolment as in New Zealand where 50% of the GPs income is a capitation payment. Such a payment needs to be adjusted for socio-economic status. This would mean that GPs working with the most vulnerable would receive more than those working in the leafy suburbs where patients’ medical needs are less and co-payments are often used to supplement income.
Aboriginal Controlled Community Health Organisations and the 80 Community Health Centres in Victoria have demonstrated the success of different models of primary health care provision. These need to be supported and expanded. Co-ordination and integration are key elements for these services, rather than optional add-ons as they often are in standard GP led practices. Primary prevention is an integral part of such practices. But we need much more on prevention. The restoration of the National Preventive Health Agency is required to identify needs and suggest actions.
Workforce planning has been all but forgotten except in small niche areas. We need big picture planning. We should not be poaching GPs and nurses from poorer overseas countries. The re-establishment of Health Workforce Australia is required to inform the way forward.
Knowing what health care is needed where should be crucial to funding decisions. A reversal of the many funding cuts to organisations that provide such data is required e.g. AIHW, ABS, Beach Report. PHNs are collecting data and this needs to be integrated so that funding goes to areas of greatest need.
You plan to have discussions with the States regarding hospital funding and to restore the 50/50 split for new funding. That’s good but you know that at the heart of the problem is the State/Federal divide. You previously had the idea of some form of National Health Commission. The idea needs to be revived but set up so that there is one single funder for health services for the nation. It needs to be devoid of politicians and health provider stakeholders. It needs to have the capacity to gather and analyse the data on health needs, including workforce and prevention. It then needs to distribute funds according to need. That would almost immediately lead to a marked increase in funding for both dental and mental health.
And in the long term you must address the grossly inequitable Private Health Insurance rebate. A yearly decrease in the rebate with saved funds going to increase public hospital capacity to cope with the expected gradual increase in demand and the current appalling wait times could restore Australians’ faith in your claim that you wish to unite the country, to care for those in need and create opportunity and growth.
Climate change and the social determinants of health require cross portfolio action but they are central to health. Your rhetoric suggests you plan to do better on climate change. Policies taken to the last election aimed to decrease the income and wealth disparities which are so clearly linked to health outcomes. Those policies need to be revived.
Much is needed. The aim should be a health system which delivers timely high quality care to everyone and emphasises that prevention of illness and promotion of health at every level can do so much more to improve health as well as productivity, to have a society which recognises that poor health is frequently a result of structural inequalities in that society. It is hoped you share this vision.
Tim Woodruff is a specialist working in private practice, past president of the Doctors Reform Society, and Chair of the Australian Health Care Alliance. The views expressed are personal.