PETER BROOKS. Will Labor Really Be Brave On Health Reform – Response To National Press Club Address By Catherine King.

Feb 20, 2019

The major challenges that beset our health system are well articulated with the obvious commitment to strengthening Medicare, making it fairer and tackling some of the major funding deficits introduced over the past decade such as the Medicare rebate freeze. The major and anticipated announcement of the establishment of the Australian Health Reform Commission is very welcome – but will it bring real change to the health system. Will preventive care and public health be funded appropriately, will we start to focus on health systems instead of just on hospitals. Lets hope so. The system needs real and probably disruptive reform – lets hope that a Labor Government will really set in place the mechanisms and governance structures for lasting change. All Australians deserve nothing less for a system that is good BUT could be GREAT.

Catherine King outlined many of the issues that have beset our health system over the past few years particularly the Medicare rebate freeze which has impacted very much on General Practitioners while specialists of all types have been able to maintain and often increase their incomes through the out of pocket expenses levied on patients. These are some of the highest in the OECD and have had an effect of making the gap between what we pay general practitioners and what we pay specialist one of the widest in the world. Is it little wonder that more graduating doctors are deciding on a career in specialty practice when we need general practitioners who are the cornerstone of our system. Health systems around the globe are challenged by how to pay for health – particularly technology but also for the workforce. We forget that health is a personnel ‘ intensive’ industry making up the largest part of the workforce in most jurisdictions.

So the announcement of the new Australian Health Reform Commission (AHRC) is welcomed. But it must have a very broad brief. Will it take on the health workforce of the future as a major issue. We should recall that one other thing that the Abbott Government did when coming to office was to get rid of Health Workforce Australia which was tasked to provide guidance particularly on the requirements and training of our future heath professionals. Delivering health care should be about having an appropriately trained health worker, with the right skills, in the right place, at the right time and at the right cost. 

The challenge of technology in health care is not just about the next imaging modality or another expensive pharmaceutical – it also about using technology to enhance / deliver health services. Take Telehealth for example – which provides a way of distant communication vie Skype, mobile phone or other communication modality in real time and at the time when the patient actually requires advice. Australia has good record of research around use of telehealth in rural /remote regions but it is not used widely across the country. It could be said the real benefits would be seen in urban settings reducing the number of patients having to be seen at outpatients as Princess Alexandra Hospital has done in Brisbane.In 2017 the Veterans Affairs system in the USA – which delivers care to over 10 million Americans in over 1000 sites carried out over 70% of its consultations using telehealth platforms. We need to revisit the health professionals / patient interaction in this new age of connectivity and offer teleconsultations to all patients if appropriate. Importantly we need to ask the patients – they often embrace this new format for consulting their health professional.

 Better use of technology would enhance either of the two early priorities identified by Shadow Minister King – better access to specialists and public health. Reviewing telemedicine item numbers might enhance uptake and could be used across the public and private system – particularly if made rebate only. Technology is also able to link communities of patients and their families – with health professionals addressing important issues of health literacy as well as monitoring patients in the community, reminding them to maintain their adherence to medication regimes, exercise programs and more.

Importantly the AHRC recommendations will be public but will the public be involved in the generation of those recommendations. We continue to develop health systems around the world without involving the public in helping to co- create those systems. It is after all a system for them – not just for health professionals – or for that matter politicians. Co-creation , co-development and very importantly co- evaluation are critical to the success of many things we deal with in society..

 Peppered though out the speech were other tantalising comments such as that about poor public dental funding – but no suggestion of a ‘Denticare‘ scheme as had been discussed by Labor in 2009.This is an area of great need not only for mouth hygiene but general health as well.

So lots of things to look forward to health wise under a Labor Government but, as always, the proof will be in the pudding and just how reformist they will be.

Health is the most important issue individuals rate and we need a government that is about equity of health services. We also need to look at the social determinants of health not in isolation but part of the whole. Things like loneliness – an increasing problem in the elderly- lack of employment and homelessness significantly impact on health. If we really believe that health is so important why doesn’t every significant policy issue considered by governments have a health impact statement attached – including policies that impact on climate change since the greatest impact of that issue is on health.

Finally AHRC needs to lead on a conversation we really don’t want to have – do we go on with an uncapped fee for service heath system which though good, is becoming increasingly unsustainable- both for the country and individuals. Do we consider health funding systems such as Canada, and how do we move to a single provider or at least a much more coordinated system of care provision across hospital and out of hospital care with appropriate incentives for keeping people out of hospital. 

 This is an exciting reform – but it MUST reform. 

Peter Brooks is a Professor in the Centre for Health Policy at the Melbourne School of Population and Global Health and Research Lead at Northern Health Epping 

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