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2014 and all that


Recall when you started a new job and you will have sympathy for the new Commonwealth Minister for Health, Peter Dutton, as he comes to terms with what his new job entails.

Health is a huge portfolio and a melting pot for interests and aspirations, whether from the community or from health service professionals, public and private. The constant tussle between the states and territories on one hand and the Commonwealth on the other is rarely far away.

Health was not a major election matter and received little airplay. There was no serious contest of policy, no incisive analyses, and no dramatic announcements about funding, and virtually no fighting.

Yet health, education, and transport are widely perceived by the electorate as top priorities. The Minister can be happy that at least health has not erupted like the volcano of schools education that spewed recently.

But election promises were made in relation to general practice.

We may well see changes that seek to render the Medicare Local development more efficient. Medicare Locals have, as might be expected, performed variably. A review may be timely to see what has worked and what has failed, the better to determine future policy.

But suggestions that Medicare Locals could be rolled into local hospital networks are in serious error.

A long history of antipathy exists between public hospitals and general practitioners.

Independent Medicare Locals guarantee space between the practitioners and the hospitals in which trust can be developed around shared programs of care.  Amalgamate the entities and my guess, based on long observation, is that the general practitioners will pick up bat and ball and leave. Coordinated care will require gentle diplomatic handling, patience and goodwill to develop trust. 

Much can be done in the current structure of Medicare locals and hospital networks to better integrate care.

It would be a singular, and splendid, achievement to fully enable general practice with information technology. Progress is occurring: I can readily recall when general practice computers were rare. It is time that as a country we took steps to achieve full IT connectivity in our health system. General practice would be a great place to begin.

So changes may occur, one hopes for the better, in general practice. 

A second area where the omens are darker is prevention. Muscular self-reliance is currently politically attractive, and the thought of adjusting social structures to support and nurture those who are less fortunate or weak lacks anabolic appeal. Nevertheless, there are serious distortions in our society that are created by the market (no, Hayek, you are not perfect) and they deserve government intervention. I refer to excess dietary fat, salt, alcohol and tobacco. 

The National Preventive Health Agency was a brave and novel attempt by the previous Government to build a serious, science-based institution to counter these distortions.

Industry will cry foul, or poor, about the Agency, insisting that if they are prevented from advertising their fat food and alco drinks at sport fixtures civilisation as we know it will end.

These voices are not the voices of the victims, but of the oppressors. They should be resisted and comprehensive national strategies for the prevention of obesity, alcohol abuse and tobacco-associated death and destruction enacted.

The recently announced national plan to combat diabetes is an excellent beginning.  Abolishing or castrating the NPHA would be a poor second act, however loud the applause from those with no interest in health.

Health care financing is an unstable policy area and two aspects of this affect the public directly. The first is out-of-pocket (OOP) expenses and the second is private health insurance. The two are, of course, related. 

Concerning out-of-pocket costs, the Australian Institute of Health and Welfare used statutory data and the Menzies Centre used Australian Bureau of Statistics direct consumer data to investigate the extent of OOP expense, and found that these payments are about $3500 a year for Australian households, and make up about 20 to 25 per cent of national health expenditure. This surcharge is especially tough on those least able to pay and those with serious and chronic illnesses, as we found through studies of such people through the Menzies Centre and the George Institute. 

Encouragement of private health insurance membership was one of the hallmarks of the previous Coalition Government, so changes back to earlier subsidy patterns may be made to encourage greater membership. The subsidy will be drawn from funds otherwise available to support universally-accessible public care. Welcome to 2014.