TIM WOODRUFF. Health Reform From Labor: Does the Policy Match the Vision?

Feb 19, 2019

ALP health spokesperson Catherine King addressed the National Press Club this week to expound Labor’s vision of health care changes if it wins office. Perhaps the highlight of the address was a restatement of Labor’s vision 

‘of a truly universal health care system in which every Australian has affordable access to the high-quality health care they need whenever they need it.’

But will such a vision be wholeheartedly pursued under a Labor Government?

She spoke of some of the problems that we all know exist in our health care. She recognised the lack of affordable and timely access to care as a major problem, although she failed to mention the 7% or more of the population who delay or don’t fill prescriptions because of Government imposed co-payments. Due mention was also made of the problems of chronic disease and complex needs. Examples of inequitable access and outcomes indicate Labor knows what the problems are and appreciates their importance.

Recognition of the need for reform to achieve this vision was apparent. Some of the barriers to reform were detailed: the split funding and responsibilities of Federal, State, and Local Government and the short political cycle with alternative governments trashing previous governments’ attempts at reform.

Apart from the expected pre-election rhetoric, the centerpiece of the presentation was the commitment to a permanent Health Reform Commission. 

‘It will be a body explicitly charged with reducing health inequality and improving the universality of our health system’

‘comparable to the Productivity Commission’

Thus, it would be expected to give apolitical advice to guide the development of policy in health care, with the particular focus mentioned. Early attention to expanding public hospital outpatient clinics and primary health care models would indeed be welcome. Combined with the stated restoration of lost public hospital funding and immediate unfreezing of the Medicare rebate, this sounds like a very good direction to address the many issues of concern. 

Its power will reside in the quality and acceptability of its advice. As with all Productivity Commission recommendations, the decision to act on that advice will depend entirely on our elected representatives. They will continue to fight amongst their various parties and levels of government. Changes may occur, but they may be reversed at the next election. Every concern outlined in the address regarding the disappointing history of reform will remain. 

It’s worth remembering a 2012 Productivity Commission report into problem gambling. The recommendation was to progress to an Australia wide poker machine pre-commitment system—under which players could set spending limits on all poker machines—by 2016. A Senate committee recommended this be mandatory. The Gillard Labor Government watered this recommendation down to voluntary and of course the Abbott Government rescinded the lot. 

The Productivity Commission has no real power. It is advisory. The suggested Health Reform Commission has no real power. It is a potential force for good only insofar as its suggestions can fit with the barriers to reform outlined by Ms King in her address, which do not look as though they will change even in the medium term future. 

But as has been pointed out by John Dwyer on this blog previously 

‘the commission must have the authority to implement change and have a vision for ten years of continuous improvement’

The vision may well be developed by such a commission. Without such authority however, lasting reform will be minimal. Perhaps hidden in the political strategy is an intention to consider giving such authority to the Commission as it evolves. Without such intention Labor cannot move significantly towards its stated vision.  

But Labor is not even demonstrating it is interested in getting useful advice about big picture items like the private health care system. Government funds 30% of the costs of private hospitals (AIHW Australia’s Health 2018) but the proposed Productivity Commission ‘root-and-branch review of the entire private healthcare system’ mentioned in the presentation ignores this funding and in particular the Private Health Insurance rebate (see my previous article on this). As well as suggesting a basic lack of knowledge of botany, such reluctance to even seek advice does not bode well for the usefulness of the proposed Health Reform Commission. 

Labor’s health policy direction is positive. It is so much better than that of the Coalition which however does set a very low bar. To date however, Labor has not demonstrated it is pursuing policies to achieve its vision. 

With this approach we will continue to have health care but not a health system. The perspective for our patients and their families will not change. The nightmare for them consists of multiple poorly connected pieces: the public hospital system, the publicly subsidised private hospital system, the GP system, the publicly subsidised private specialist system, the community care system, the publicly funded private allied health system, the mental health system, the private dental system, the publicly funded private dental system, the public dental system, the Aged Care system, and a myriad of other pieces. We can do better. 

Dr Tim Woodruff is president of the Doctors Reform Society, an organisation of doctors and medical students promoting measures to improve health for all, in a socially just and equitable way.  On twitter @drsreform

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2 thoughts on “TIM WOODRUFF. Health Reform From Labor: Does the Policy Match the Vision?

  1. Dear Tim,

    I too agree.

    The disconnection between Commonwealth funded and subsidised primary health networks, general practitioners and related services, highly selected NGOs and the fundamental and basic public health system and services, run by state governments, is the greatest barrier to health equity. Take for example the way ‘mental health’ services are funded and organised. Firstly, it is the state systems that do the heavy lifting – public mental health facilities, public community mental health services, mental health services for the elderly (and troubled youth), forensic ‘mental’ health services and facilities, and more. They deal with the messy and troublesome problems of the overlap between policing, gaols, involuntary treatment through legislated Mental Health Acts, ambulance call outs, drug overdoses and so. This is tough stuff, and essential. The Commonwealth on the other hand barely touches any of these areas and now funds its ‘mental’ health commitments through competitive funding of Primary Health Care Networks which are supposed to work with and liaise with ‘mental’ health and drug and alcohol NGOs, again selected on the basis of competitive funding – not according to unmet need. This separation applies to other areas of health care/services as well, especially in the management of chronic disease and comorbidities which have their greatest impact on socially and geographically disadvantaged communities.

  2. Hi Tim,

    Agreed. But will an integrated system do better? It doesn’t address the motivation of those in power (the pollies).

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