SHOULD we pay more from our pockets for health care and less from the public purse?
What current institutions in health can we do without? Should prevention be a major concern of government or should it be left to the individual?
These questions should be addressed by a national government elected to oversee — among many things — the health of the nation.
Much health care in Australia is paid for from taxes. A long history explains why this is so, much of it expressing humane concern for people who are sick and assuring access to care for those who are not so well off financially.
Our politicians have choices — they can leave the health system as it is or they can try to change it by changing the underpinning policy. In seeking to make change they inevitably provoke the interest of those who stand to lose or gain as a result — doctors, nurses, patients, managers, insurers, pharmaceutical companies and many others.
So, whether they leave the system mostly in place and merely fiddle, or propose branch and root changes, politicians are engaging in policy decisions whether they recognise it or not (policy in this case being deciding how to apply resources available for health care).
These policy decisions affect people’s lives and are not trivial. For example, increasing the privatisation of health care, as has been proposed in Queensland, carries costs for those least able to pay.
The more privatised the system, the less the needs of the poor and the marginal are met. This in turn means that society is changed and the values that it expresses — a fair go for all and concern for the weak — are hammered in the promotion of profit.
The results of a two-tiered health system are rapid access to quality care for the rich, who pay privately, and inferior care with long waiting times for the poor through a publicly funded safety net, a system well known in less developed countries.
Because it involves money, the health policy debate occurs in the context of other public policy discussions, most notably those that have to do with the Budget. Former senator, doctor and colleague, Professor Peter Baume, used to say that matters of principle usually turned out in politics to be matters of money, while matters of high principle usually turned out to be matters of lots of money. He could have been talking about matters of health policy.
As the word implies, policy has to do with the polis — the people. In a democracy the people expect their voices will be heard, alongside those of experts in health, the financial controllers and other interest groups. They also expect that changes to the system are canvassed with them before being announced and that they have a chance to have their say.
Optimally, a competitive, comprehensive statement of intent for health care would be provided by contestants for our vote at each election. This did not happen at the last federal election and we have not been canvassed about proposed changes.
Instead we have been bombarded in the past few weeks by government and the media about proposed cuts in tomorrow’s federal Budget, rumours of extinctions (eg, the Australian National Preventive Health Agency and Medicare Locals), increased costs to visit GPs and nothing much about our public hospital system.
It would be healthy if tomorrow’s Budget acknowledged the need for people-based health policy.
We should be presented with options that emanate from clear-headed policy thinking as well as a sound budget. The publication recently of the National Commission of Audit report is not reassuring. It focuses heavily on the supply side of the cost equation for health care but does not provide any insights into what can be done to achieve real efficiency through structural change. Instead, we just hear about rising charges through copayments and by forcing high-income earners out of Medicare and into private insurance schemes.
How to achieve more efficient (and generally more effective) care is left unconsidered. For example, in the Western Sydney Local Health District in the past 2 years, we have cut millions of dollars from our recurrent budget with an 8% increase in activity by attending to contracting, procurement and not using expensive part-time staffing from a budget of a mere $2.4 billion.
Let’s have less haste and hysteria, and more speed towards an efficient and humane health system, thank you.
Professor Stephen Leeder is the editor-in-chief of the MJA and professor of public health and community medicine at the University of Sydney. He chairs the Western Sydney Local Health District Board.